Cass County, North Dakota Health Care Facilities Variable Rate Demand Revenue Bonds, Series 2008A (Essentia Health Obligated Group)

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1 \\~ Essentia Health Here with you November 20, 2012 Anita Malmgren Trust Review Analyst US Bank National Association Corporate Trust Services EP-MN-WS3C 60 Livingston Avenue St. Paul, MN Executive Offices 502 East 2nd Street Duluth, MN EssentiaHealth.org Re: Duluth Economic Development Authority Health Care Facilities Revenue Bonds (Benedictine Health System-St. Mary's Duluth Clinic Health System Obligated Group) Series 2004 Dear Ms. Malmgren: Cass County, North Dakota Health Care Facilities Variable Rate Demand Revenue Bonds, Series 2008A (Essentia Health Obligated Group) Minnesota Agricultural and Economic Development Board Health Care Facilities Variable Rate Demand Revenue Bonds, Series 2008C (Essentia Health Obligated Group) Minnesota Agricultural and Economic Development Board Health Care Facilities Revenue Bond, Series 2011A (Essentia Health Obligated Group) We hereby certify that the quarterly financial statements enclosed herein are the Quarterly Financial Statements required by Sections 3(d) and 3(c) of those certain Continuing Disclosure Agreements executed and delivered by Essentia Health, on behalf of itself and each of the other Members of the Obligated Group and U.S. Bank Trust National Association dated as of March 1, 2004; March 4, 2008 and March 29, 2011 (the "Agreemenf'), respectively. If you have any questions about this matter please do not hesitate to call. E/JZiP)~ RobertJ.Norman,CPA Chief Financial Officer Enclosure US Bk st qtr.doc Quality I Hospitality I Respect I Justice I Stewardship I Teamwo rk

2 Essentia Health Unaudited Financial Statements For the Period and Fiscal Year-to-Date September 30, 2012

3 \\11 Essentia Health Consolidating Balance Sheet (In Thousands) SeJ>tember 30, 2012 September 30, 2011 Non Oblipted Obllpted Non Oblipted Oblipted Group Group Eliminations Consolidated Group Group Eliminations Consolidated Assets Current assets: cash and cash equivalents s 48,991 s 14,736 s s 63,727 s 53,684 s 15,219 s s 68,903 Short-term investments 8,072 3,313 11,385 6, ,991 Current portion of assets whose use is I imited 11,216 9,320 20,536 21,764 8,663 30,427 Patient accounts receivable, less allowances fur uncollectible accounts 209,094 24, , , ,140 Amounts due from affiliates 6,068 (6,068) 521 4,088 (4,609) Prepaid expenses and other receivables 29,192 5,082 34,274 31,.200 5,023 (297) 35,926 Inventories 26,366 2,903 29,269 22, ,344 Total current assets 338,999 59,841 (6,068) 392, ,475 58,162 (4,906) 412,731 Assets whose use is limited.. less. current portion Funds desisnated by board 427,058 10, , ,059 12, ,287 Funds hl!ld by trustee 3, ,656 3, ,838 Other 36,472 56,827 93, ,839 80,42.1 Total auets whose use is limited 466,854 67, , ,301 65, ,546 Property and equipment. net 544,890 56, , ,668 41, ,716 Intangible and other noncurrent assets. net 118,457 3, , ,712 2,374 (500) 120,646 Total assets $ 1,469,200 $ 186,72.1 $ (6,068) $ 1,649,853 $ 1,4l8,216 $ 166,1119 $ (5,406) $ 1,589,639 UabUitles and Net AsSI!!ts Current liabilities: Accounts payable s s 6,883 s (3.153) s $ 30,143 s 3,713 s (1.204) s 32,652 Payable to third-party payors 10,257 2.,021 12,278 17, ,787 Acaued liabilities: Salaries, wages and benefits 84,691 6,804 91,495 88,044 6,009 94,053 Interest ,603 2, ,957 Amounts due to affiliates 2,915 (2,915) (3,702) Current portion of long-term debt 15,965 1,641 17,606 12, ,465 Other current liabilitii!s 15,566 7,156 22,722 17,557 5,709 23,266 Total cunrent liabilities 149,905 27,556 (6,068) 171, ,611 22,475 (4.906) 186,180 lang-term debt 497, , ,529 28,592 (500) 551,621 Professional, pension, and other noncurrentliabilities 2.03,938 6, , ,202 8, ,680 Total liabilities 851,408 67,388 (6,068) 912, ,342 59,545 (5,406) 897,481 Net assets: Unrestricted 617, , , ,168 Temporarily Restricted 91 15,632 15, ,189 14,281 Permanently Restricted Total net assets 617, , , , , ,158 Total liabilities and net assets $ 1,469,200 $ 186,721 s (6,068) $ 1,649,853 $ 1,428,216 s 166,829 $ (5,406) $ 1,589,639

4 Essentia Health ' r Consolidating Statement of Revenues and Expenses (In Thousands) Three Months Ended septamber 30, 20U Three Months Ended Seetember Non ObUgated Non Obllpted Obligated Group Group Eliminations ConsoUdated Obl!l!ted Group Group Eliminations Consolidated U nrestrlcted revenue: Net patient revenue s 360,705 s 33,060 s (131) s 393,634 s 349,331 s 34,741 s (139) s 383,933 Provision for bad debt [17,733). (1.313) (19,046) (15,739) (1.758) (17.497) Net patient revenue less provision for bad debt 342,972 31,747 [131) 374, ,592 32,983 (139) 366,436 Other operating revenue 17,136 3,873 (3,798) 17,211 22,936 3,795 (4,706) Total unrestricted revenue 360,108 3S,620 (3,929) 391, ,528 36,778 (4,845) 388,461 Expenses: Salaries, waees. and related benefits 221,986 22,177 (1,599) 242, ,847 22,658 (2,252) 235,253 Professional fees 5,132. 1,651 (111) 6,672 4, (116) 6,U9 Supplies 52, ,047 55, ,133 Purchased services 12, (800) 15,013 14,003 2,696 (755) 15,944 Professional liability and general insurance 2, (1,277) , (1,561) Utilities 4, ,858 4, ,861 Repairs and maintenance 7, ,353 5,93S 560 6,495 Other 18,915 4,308 (142) 23,081 20,027 3,775 (124) 23,678 Total e><penses before interest, depreciation and amortization 325,802 36,147 (3,929) 3S8, ,864 (4,808) 353,024 Earnings before Interest,. depredation and amortization (EBIDA) 34,306 (527) 33,779 34, (37) 35,437 M""''n 9~ 1.5" o.ca 8.6% 9.7% 2.5" 0.8% 9.1" Interest 5, ,522 4, ,281 Depredation and amortization 16, ,279 15, ,598 Total intere."t, depredation and amortization 21,933 1,868 23,801 20,297 1,582 21,879 Income (loss) from operations 12,373 [2,395) 9,978 14,263 (6681 (37) 13,558 Marsln 3.4" ~. :1% 0.0% 2.5" 4.11% 1.8% 0.8% 3.5" Nonoperatina gains (losses), net: Investment income on funds desi&nated by Board , ,100 Net realited sains [losses) 3, 131 1,182 4, (869) (465) Net change in unrealized pins (losses) on trading securities 10,013 1,219 11,232 (36,106) (2.905) (39,011) loss on disposal of property Gain (loss) on swap agreements (12,277) (12.277) Gain (loss) on investments in joint ventures 1, , Other, net Total nonoperating gains (losses) , ,340 (46,477) (3,494) (49,971) Excess (detlcitl of revenue and &ains over e><penses $ 29,010 $ 308 $ - $ 29,318 $ (32,2141 $ (4,16lj $ j37l $ (36,413) Marsln 7.:1% 0.8% 0.11% 7.1" 10.4" -U~ 0.8% 10.8%

5 Unrestricted net assets Excess af revenue. and gajns over expenses Net chanae In unrealized gains (lasses) on other-thantrading S<!C\Irlties Contribution oflong-lhted assets Other~ net Increase (deaeasel in unrestncted net assets Obligated Group s 29, (1.380) Essentia Health Consolidating Statement of Net Assets {In Thousands) Thn!e Months Ended September 30, 20U Non Obliaated s Graue 308 9,661 1, s 9imlnatlons - s COasolldated 29, ,66l (314) 38,706 Thn!e Months Ended September 30, 1011 Non Obligated ObU!!!ed Graue Gro~ 91mlnatlons ConsoRdated s (32,214) s (391 (5,595) (37,848) (4,162) s (19) 1,478 (2.703) (37) s 37 (36,413) (58) (4,080) (40,551) Temporarily restricted net assets Contributions Other. net 653 (435) 653 (435) 5 (10) 349 (1,899) 354 (1,909) lncrejise (decrease) in temporarily restricted net assets (S) (1,550) (1,555) Permanently restricted net assets Other, net Increase (decrease) in permanently restricted net assets lnaease (d~ase} in net assets Net assets at beaimina of year Net asmts bl date H, ,U1 617,7!U , ,333 38, , ,125 (37,853) 622, ,874 (4,2.53) 111, ,284 (42.106) 734,

6 Essentia Health Consolrdating Statement of Statistics Three Months Ended September 30, 2012 Three Months Ended Seetember 30, 2011 Non Obli&ated Non Oblipted Obli&ated Group Grou!! Eliminations Consolidated O!!!!l!ted Groul! Groue Eliminations Consolidated Outpatient Statlstia Relative value unit ,127 16,089 1,059, ,159 8, ,503 Oinic encounters 375,148 20, , , ,421 Hospital outpatient visits 98, ,030 U7,718 Hospital emergency room visits ,627 37,852 31,019 6, Hospital outpatient SU'lleries 4, , ,042 Inpatient statistics Hospital patient discha'lles 9, ,596 10,078 1, Hospital patient days ,846 41,008 3,870 44,878 Hospital average daily census Occupancy rate(%)- available beds 54-.0'!6 17.0% 0.0% 47.6% 52.3% 22.9% 0.0% 47.1% Hospital average lenatt> of stay Hospital inpatient su'l!eries 3, ,709 3,525 7l 3,596 Medicare case mix index N/A N/A N/A N/A Hospital bed days available 78, ,116 78,384 16,928 95,3U long-term care resident days 8,348 23,594 31,942 8,178 23,766 31,944 Full time equlllalents (FTE's)! Physicians /IPC and Other staff ,215 9,539 8,383 1,148 9,532 long-term care s!jiff Total FI'E's 9, ,548 9, Beds Ucensed beds Hospital , Ucensed beds lons-term care Available beds - Hospital , ,036 Available beds long term care