Flower:

1 or 2 (rarely 3) stalked flowers dangling at branch tips. Each bell-shaped flower is 1/3 to about 2/3 inch (8 to 15 mm) long with 6 narrow, widely flaring, creamy to greenish-white tepals (petals and similar sepals). 6 yellow stamens and a 3-lobed style all about as long as the tepals extend out of the tube. Flower stalks are stout and hairy.

Leaves and stems:

Leaves are alternate, 1½ to 4+ inches (4 to 12 cm) long, to 2 inches (2 to 5 cm) wide, lance-oblong to egg-shaped, sharply pointed at the tip, rounded to heart-shaped at the base, stalkless, with several prominent veins radiating from the base.

The lower surface is sparsely to moderately hairy; edges are toothless and fringed with short hairs. Stems are single, erect, sparsely to moderately hairy, and few branched, the branches spreading to ascending.

Fruit:

Fruits are initially green and 3-sided, maturing to a round berry ½ to ¾ inch (12 to 18 mm) diameter, reddish-orange or bright red when ripe, has a warty texture, and contains 6 to 12 seeds.

Notes:

Rough-fruited Fairybells is very rare in Minnesota. It is primarily a western species ranging from New Mexico and Arizona to northern British Columbia with only a handful of known locations east of Manitoba, Canada, most of which are in central and northern Ontario. According to the DNR, it was first discovered here in northern Cook County near the Canadian border in 1999; a second population in the same general area was found in 2014. Its shady upland forest habitat is actually rather fragile since the known MN sites are loose soils over a rocky terrain held together by a thread, and subject to erosion and dislocation from natural disturbances such as downed trees. It was listed as Endangered in 2013.

When flowering or fruiting, it is recognized by the 1 or 2 whitish, 6-petaled flowers (or round bright red or orangish fruits) at branch tips, hairy leaves and stems, and few ascending to spreading branches. Very similar are the Streptopus species, which have flowers/fruits arising from the leaf axils rather than just at branch tips. Vegetative plants can be difficult to distinguish from Rose Twisted-stalk (S. lanceolatus) in particular, which tends to be a smaller plant; Clasping-leaved Twisted-stalk (S. amplexifolius) has more strongly clasping leaves, is hairless and more heavily branched.