GOOD SAMARITAN HOSPITAL ASSOCIATION: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SAMARITAN HOSPITAL ASSOCIATION (EIN 45-0226419)
- Tax period
- 2023-04-01 to 2024-03-31
- Filed
- 2024-09-24
- IRS object ID
- 202402689349300820
- Schema version
- 2023v5.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-09-24T15:33:18-05:00 | ReturnTs |
| Tax Period End | 2024-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4585 Coleman St Ste 200 | AddressLine1Txt |
| City | Bismarck | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58503 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450226419 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Hospital Association | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GOOD | BusinessNameControlTxt |
| Phone | 7017765261 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 South Main Avenue | AddressLine1Txt |
| City | Rugby | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 583682118 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Melissa Shepard | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7017765261 | PhoneNum |
| Signature | 2024-09-23 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Lisa Chaffee CPA | PreparerPersonNm |
| PTIN | P00193453 | PTIN |
| Phone | 7012551091 | PhoneNum |
| Preparation | 2024-09-23 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2024-08-08 14:25:15Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Heart of America Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Erik Christenson | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 South Main Avenue | AddressLine1Txt |
| City | Rugby | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 583682118 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $33,488,643 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.hamc.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1905 | FormationYr |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Activity Or Mission | Provide quality medical care based on the needs and demographics of north central North Dakota. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 347 | TotalEmployeeCnt |
| Total Volunteers | 40 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,678,984 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,725,570 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $28,239,433 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $31,217,303 | CYProgramServiceRevenueAmt |
| PY Investment Income | $184,937 | PYInvestmentIncomeAmt |
| CY Investment Income | $437,575 | CYInvestmentIncomeAmt |
| PY Other Revenue | $5,450,896 | PYOtherRevenueAmt |
| CY Other Revenue | $65,120 | CYOtherRevenueAmt |
| PY Total Revenue | $37,554,250 | PYTotalRevenueAmt |
| CY Total Revenue | $33,445,568 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $50,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $17,782,748 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $18,634,921 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $80,466 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,777,804 | PYOtherExpensesAmt |
| CY Other Expenses | $12,685,255 | CYOtherExpensesAmt |
| PY Total Expenses | $28,691,018 | PYTotalExpensesAmt |
| CY Total Expenses | $31,320,176 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $8,863,232 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,125,392 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $34,054,250 | TotalAssetsBOYAmt |
| Total Assets EOY | $71,154,311 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,159,564 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $40,090,165 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $28,894,686 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $31,064,146 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | To deliver compassionate care by advancing the physical and spiritual well-being of the communities we serve through smart medicine and exceptional service. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $27,473,939 | ExpenseAmt |
| Revenue | $31,217,303 | RevenueAmt |
| Desc | Good Samaritan Hospital Association (GSHA) is a nonprofit healthcare organization owned by 20 local churches representing all Christian denominations in the area. Each year, these churches elect a board of trustees at an annual meeting, and this board serves as the legal governing body responsible for the Association. GSHA is dedicated to providing comprehensive healthcare services to the community of Rugby, ND, and its surrounding areas.GSHA operates a 25-bed licensed acute/swing bed critical access hospital, three rural health clinics (located in Rugby, Dunseith, and Maddock), a surgery department, a provider-based surgical clinic and (Continued on Schedule O)pain clinic, 18 skilled nursing home beds, 60 basic care beds, and 37 assisted living apartments. Additionally, we offer a robust hospital-based hospice program, serving the community with compassionate end-of-life care.In response to the current economic challenges and the lingering effects of COVID-19, we have seen an increase in the need for charity care. To address this, GSHA provided an estimated $244,000 in charity care services for the year ending March 31, 2024 (calculated by multiplying the ratio of costs to gross charges for the Organization by the gross uncompensated charges associated with providing charity care to its patients). Our CEO has actively engaged the community through numerous health updates on the radio, educating the public about new initiatives and changes from CMS.GSHA also offers a variety of community and social programs, including reduced-fee flu shot clinics, a diabetic education program, chronic care management, and public healthcare educational initiatives. We participate in health shows and community events, provide ambulance volunteers, and offer EMT courses. Our educational outreach extends to local schools, senior citizen meals through the Meals on Wheels Program, free blood pressure checks, physical therapy services, and wellness programs. Additionally, we provide meeting space for various organizations and churches, and offer CPR training.Furthermore, we have established strong relationships with CNA, LPN, and RN school programs through a consortium of facilities and colleges, supporting the education and training of future healthcare professionals.GSHA remains committed to improving the health and well-being of our community through comprehensive and compassionate care.Our Diabetes Education program offers various nutrition classes focused on maintaining and controlling diabetes. Through our 340b program, patients can request free test strips from our DME department, ensuring they have the necessary supplies for effective diabetes management. Furthermore, we host a monthly diabetes support group to assist patients and their families in managing the condition through shared experiences and expert advice.The Ambulance Service is operated by GSHA after the community was unable to sustain it as a volunteer service. We staff the ambulance 24/7, respond to all 911 calls in our area, and provide community services such as home blood draws for those unable to make it to the hospital. The operation of the ambulance service is subsidized through a mill levy and a state grant. | Desc |
| Total Program Service Expenses | $27,473,939 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 37 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 347 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Erik Christenson | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7017765261 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 South Main Avenue | AddressLine1Txt |
| City | Rugby | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 583682118 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| Wayne Trottier | |||||||||
| President | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Michael Graner | |||||||||
| Vice Chair | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Craig Zachmeier | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Kolin Johnson | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Kim Bott | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Tanner Johnson | |||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Will Griffin | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Travis Maddock | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Lisa Thorp | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Erik Christenson | |||||||||
| Secretary - CEO | 58.00 | 2.00 | Yes (X) | $153,379 | $0 | $44,032 | |||
| Melissa Shepard | |||||||||
| Treasurer - CFO | 58.00 | 2.00 | Yes (X) | $137,138 | $0 | $15,966 | |||
| Dustin Hager | |||||||||
| COO & Provider | 40.00 | 0.00 | $201,996 | $0 | $45,594 | Yes (X) | |||
| Ronald Skipper MD | |||||||||
| Surgeon | 40.00 | 0.00 | $375,294 | $0 | $42,988 | Yes (X) | |||
| Cammy Kelsch FNP-C | |||||||||
| ER Provider | 66.50 | 0.00 | $276,302 | $0 | $45,703 | Yes (X) | |||
| Josalynne Hoff Rue MD | |||||||||
| Physician | 40.00 | 0.00 | $317,795 | $0 | $45,516 | Yes (X) | |||
| Steven Schoneberg MD | |||||||||
| Physician | 40.00 | 0.00 | $284,605 | $0 | $39,248 | Yes (X) | |||
| Chelsey Wyatt | |||||||||
| CRNA | 40.00 | 0.00 | $298,617 | $0 | $47,444 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,045,126 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $326,491 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 20 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Reverb Parent Inc | |||||
| PO Box 850737 | Minneapolis | MN | 55485 | Contract labor services | $859,069 |
| Eide Bailly LLP | |||||
| PO Box 2545 | Fargo | ND | 58108 | Audit and Professional Services | $263,296 |
| Mike Swanson Construction | |||||
| 6250 24th Ave NE | Rugby | ND | 58368 | General Construction | $186,298 |
| Envision Co-operative | |||||
| 105 4th Ave SW | Rugby | ND | 58368 | Propane tank and fuel installation | $154,154 |
| Facilities Asset Management | |||||
| 15739W HWY 2770 | Stone Lake | WI | 54876 | Project owners representative | $132,789 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $923,173 | RelatedOrganizationsAmt |
| Government Grants | $753,937 | GovernmentGrantsAmt |
| All Other Contributions | $48,460 | AllOtherContributionsAmt |
| Total Contributions | $1,725,570 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 621400 | $27,743,119 | $27,743,119 |
| Pharmacy Revenue | 456110 | $2,311,424 | $2,311,424 |
| Cafeteria Revenue | 722514 | $213,563 | $213,563 |
| Daycare Services | 812900 | $189,330 | $189,330 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $759,867 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $759,867 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $31,217,303 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $454,397 | TotalRevenueColumnAmt |
| Exclusion | $454,397 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $65,120 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $65,120 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $65,120 | TotalRevenueColumnAmt |
| Exclusion | $65,120 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $26,253 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $43,075 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$16,822 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$16,822 | TotalRevenueColumnAmt |
| Exclusion | -$16,822 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $33,445,568 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $31,217,303 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $502,695 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $633,177 | TotalAmt |
| Program Services | $190,784 | ProgramServicesAmt |
| Management And General | $442,393 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $207,002 | TotalAmt |
| Program Services | $207,002 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,248,582 | TotalAmt |
| Program Services | $12,763,636 | ProgramServicesAmt |
| Management And General | $1,484,946 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $342,183 | TotalAmt |
| Program Services | $307,293 | ProgramServicesAmt |
| Management And General | $34,890 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,172,402 | TotalAmt |
| Program Services | $1,945,561 | ProgramServicesAmt |
| Management And General | $226,841 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,031,575 | TotalAmt |
| Program Services | $902,836 | ProgramServicesAmt |
| Management And General | $128,739 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,871 | TotalAmt |
| Management And General | $65,871 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,936 | TotalAmt |
| Management And General | $20,936 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,464,788 | TotalAmt |
| Program Services | $3,017,346 | ProgramServicesAmt |
| Management And General | $447,442 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,283 | TotalAmt |
| Management And General | $47,283 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $340,713 | TotalAmt |
| Program Services | $194,189 | ProgramServicesAmt |
| Management And General | $146,524 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,107 | TotalAmt |
| Management And General | $31,107 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,335,730 | TotalAmt |
| Program Services | $1,222,244 | ProgramServicesAmt |
| Management And General | $113,486 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,179 | TotalAmt |
| Program Services | $58,792 | ProgramServicesAmt |
| Management And General | $16,387 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,589 | TotalAmt |
| Program Services | $48,338 | ProgramServicesAmt |
| Management And General | $48,251 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,466 | TotalAmt |
| Program Services | $25,466 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,085,104 | TotalAmt |
| Program Services | $1,843,688 | ProgramServicesAmt |
| Management And General | $241,416 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $287,940 | TotalAmt |
| Management And General | $287,940 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $3,582,242 | $3,582,242 | |
| Repairs & Maintenance | $494,949 | $494,949 | |
| Food | $430,126 | $430,126 | |
| Dues and Subscriptions | $54,209 | $2,872 | $51,337 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $247,023 | TotalAmt |
| Program Services | $236,575 | ProgramServicesAmt |
| Management And General | $10,448 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,320,176 | TotalAmt |
| Program Services | $27,473,939 | ProgramServicesAmt |
| Management And General | $3,846,237 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,624,770 | BOYAmt |
| EOY | $8,398,455 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,665,542 | BOYAmt |
| EOY | $3,164,270 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $233,578 | BOYAmt |
| EOY | $201,683 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $319,007 | BOYAmt |
| EOY | $334,709 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $59,730,795 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $14,022,863 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,696,721 | BOYAmt |
| EOY | $45,707,932 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $139,693 | BOYAmt |
| EOY | $1,695,356 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $114,222 | BOYAmt |
| EOY | $177,248 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,260,717 | BOYAmt |
| EOY | $11,474,658 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,054,250 | BOYAmt |
| EOY | $71,154,311 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,698,588 | BOYAmt |
| EOY | $7,847,988 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,892 | BOYAmt |
| EOY | $17,269 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $31,289,626 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,444,084 | BOYAmt |
| EOY | $935,282 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,159,564 | BOYAmt |
| EOY | $40,090,165 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,669,988 | BOYAmt |
| EOY | $25,774,368 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,224,698 | BOYAmt |
| EOY | $5,289,778 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,894,686 | BOYAmt |
| EOY | $31,064,146 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,054,250 | BOYAmt |
| EOY | $71,154,311 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,125,392 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $11,701 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $32,367 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $1,647 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | Yes (1) | DirectContactLegislatorsInd |
| Direct Contact Legislators | $0 | DirectContactLegislatorsAmt |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $1,647 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | GSHA engages in lobbying through its membership dues to the American Hospital Association (AHA), the North Dakota Hospital Association (NDHA), and the North Dakota Long Term Care Association (NDLTCA). These organizations advocate for their members by supporting legislation that aligns with their collective interests. They strive to ensure that laws and regulations are fair and equitable, enabling healthcare facilities to provide affordable, high-quality care, especially in rural areas. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $56,998 | BeginningBalanceAmt |
| Additions During Year | $61,718 | AdditionsDuringYearAmt |
| Distributions During Year | $29,005 | DistributionsDuringYearAmt |
| Ending Balance | $89,711 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $417,447 | OtherCostOrOtherBasisAmt |
| Book Value | $417,447 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,639,511 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,330,422 | DepreciationAmt |
| Book Value | $1,309,089 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,182,836 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,692,441 | DepreciationAmt |
| Book Value | $1,490,395 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $42,491,001 | OtherCostOrOtherBasisAmt |
| Book Value | $42,491,001 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $45,707,932 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (5 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Beneficial Interest in Assets Held by Others | $4,877,299 |
| Insurance Receivable | $500,000 |
| Employee Retention Credit Receivable | $5,560,429 |
| Finance Lease (net of accumulated amortization) | $507,525 |
| Operating Lease | $29,405 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $11,474,658 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| Insurance Payable | $500,000 |
| Related Party | $804 |
| Operating Lease Liability | $28,997 |
| Finance Lease Liability | $290,481 |
| Estimated third-party payor settlem | $115,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $935,282 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $33,460,631 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $11,701 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $65,080 | OtherRevenueAmt |
| Revenue Not Reported | $76,781 | RevenueNotReportedAmt |
| Revenue Subtotal | $33,383,850 | RevenueSubtotalAmt |
| Other Revenues Not Included | $61,718 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $61,718 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $33,445,568 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $31,291,171 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $31,291,171 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $29,005 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $29,005 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $31,320,176 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 1b: | The Auxiliary, managed by volunteers under the Good Samaritan Hospital Association, is dedicated to supporting patients and residents. This volunteer organization maintains the funds, which are allocated for various activities, including the operation of a gift shop. A governing Board oversees the distribution of these funds to ensure they are used effectively. |
| Part IV, Line 2b: | The Organization acts as custodian for the funds of the nursing facility residents and Haaland Estates residents. |
| Part X, Line 2: | The Organization believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
| Part XI, Line 2d - Other Adjustments: | Change in interest in net assets of Foundation 65,080. |
| Part XI, Line 4b - Other Adjustments: | Auxillary Revenue 61,718. |
| Part XII, Line 4b - Other Adjustments: | Auxillary Expenses 29,005. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $244,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $244,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00780 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $244,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $244,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00780 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $25,067 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $25,067 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,860,673 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,391,531 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,469,142 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04690 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,885,740 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,391,531 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,494,209 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04770 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,129,740 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,391,531 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,738,209 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05550 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $278,274 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $69,569 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,338,616 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,371,395 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$32,779 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Heart of America Medical Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 S Main Ave | AddressLine1Txt |
| City | Rugby | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 583682118 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.hamc.com | WebsiteAddressTxt |
| State License | 5046 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Heart of America Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | https://www.hamc.com/CHNA/ | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | See Part V, Page 8 | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.hamc.com/CHNA/ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://www.hamc.com/patient-forms#CCP | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://www.hamc.com/patient-forms#CCP | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://www.hamc.com/patient-forms#CCP | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Heart of America Medical Center | Part V, Section B, Line 5: Our initial task force involved public health, city government, local school, pastoral and HAMC representation. Our community meetings involved those areas along with agricultural, business owners, first responders, and social services representation from our service area. We collaborated with Lake Region District Health Unit for conducting our CHNA. The representative from our local office attended task force meetings, distributed surveys to patients, was involved in press releases and participated in community meetings. Surveys were available online as well as paper in several locations. Throughout the process, task force and community meetings were held intermittently from September 2021 through January 2022. CRH conducted community interviews for informational purposes. |
| Heart of America Medical Center | Part V, Section B, Line 6b: Lake Region District Health Unit & UND Center for Rural Health |
| Heart of America Medical Center | Part V, Section B, Line 11: In the most recent CHNA conducted the following needs were identified: attaining and retaining young families/ having enough daycare services, availability of mental health services, and not enough healthcare staff in general.The organization will not address cost of health insurance, jobs with livable ages, and affordable housing needs due to limited resources and the need to allocate significant resources to the three priority health needs identified above.In the current year, the organization has taken significant steps to address the availability of current providers and to educate the community about their services. These providers offer mental health screenings, treatment, care within their scope of practice (SOP), and referrals to specialists when necessary. Additionally, the organization has improved staff benefits to ensure livable wages. Enhancements include updates to the 401(k), short-term disability, and daycare programs, resulting in increased employee retention and financial well-being.The organization has also reduced healthcare insurance premiums by offering low-cost insurance options, significantly impacting employees' net income positively. By working with the NDHA Health Trust as a self-funded plan, the organization continues to seek ways to reduce costs for employees, ultimately benefiting the community by increasing local spending.Moreover, the organization has expanded daycare capacity to better support employees and reduce the strain on local daycare resources. However, there remains a need for additional daycare options in the area |
| Heart of America Medical Center | Part V, Section B, Line 15e: As part of the application process the patient will provide name, demographic information, occupation, employer, spouses demographic information, dependent information, and insurance information. Documentation that may be required to assist with processing of application to include pay stubs, itemized income and expenses, verification from welfare agency, verification from unemployment or workers compensation, or income tax returns as supporting documentation. |
| Part V, Line 7b: | Other Website:https://ruralhealth.und.edu/projects/community-health-needs-assessment/reports |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 7 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Heart of America Johnson Clinic | ||||
| 800 S Main Ave | Rugby | ND | 58368 | Rural Health Clinic |
| 2 - Heart of America Johnson Clinic | ||||
| 215 Main St SE | Dunseith | ND | 58329 | Rural Health Clinic |
| 3 - Heart of America Johnson Clinic | ||||
| 301 Roosevelt Ave | Maddock | ND | 58348 | Rural Health Clinic |
| 4 - Heart of America Nursing Facility | ||||
| 800 S Main Ave | Rugby | ND | 58368 | Long-term Skilled Care Nursing Facility |
| 5 - Heart of America Hospice | ||||
| 800 S Main Ave | Rugby | ND | 58368 | Hospice care |
| 6 - Haaland Estates Basic Care | ||||
| 1025 3rd Ave SE | Rugby | ND | 58368 | Basic Care Nursing Facility |
| 7 - Haaland Estates Assisted Living | ||||
| 1025 3rd Ave SE | Rugby | ND | 58368 | Assisted Living Facility |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Community Health Improvement Services, line 7e, reflects actual expenses recorded to the general ledger. Subsidized health services, line 7g, were calculated based on information from the Cost Report. |
| Part III, Line 2: | The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concession based on its historical collection experience with this class of patients. |
| Part III, Line 3: | The Organization estimated the implicit price concessions attributable to patients who likely would qualify for financial assistance by applying the percentage of financial assistance applications sent out but not received back or not completed. |
| Part III, Line 4: | The footnote to the Organization's financial statements related to implicit price concessions can be found on page 14-15 of the attached audited financial statements. |
| Part III, Line 8: | Medicare allowable costs were obtained from the Medicare Cost Report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.Good Samaritan Hospital Association is a critical access hospital and is reporting a Medicare shortfall due to sequestration. Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit. |
| Part III, Line 9b: | Our accounts are worked effectively and thoroughly with self-pay statements printed monthly once insurances have met their obligations. The goal is to obtain payment in full, establish acceptable payment arrangements, and look at other appropriate agencies or low income programs, or offer the charity care program if needed. In the collection process, the bill guarantor is reminded they may qualify for our charity care program and are given information on how to apply. Our third party collection company also offers charity care during collection calls. The statements explain who to call for a charity care application. Our charity program is income based and patients have 120 days to submit a financial assistance application, and uses 200% of the Federal poverty guidelines. If they qualify, the bill is written off 100% to charity care. Once approved they qualify for assistance for 6 months before and 6 months after of the approval date. After 120 days in collections, the account is written to bad debt. At least 30 days before we take extraordinary collection action we send notification. Up to 240 days we accept applications and stop collection actions and reverse the collection effort. |
| Part VI, Line 2: | Heart of America Medical Center (HAMC) and its associated facilities proudly serve a close-knit community where healthcare providers personally know their patients. GSHA board members, who reside in these communities, are tasked with bringing back community concerns to ensure that the needs of the community are prioritized. We also greatly value the insights and feedback provided by the HAMC Auxiliary Board, as well as the dedicated efforts of dozens of volunteers who collectively contribute thousands of hours to our hospital and long-term care facilities. |
| Part VI, Line 3: | Good Samaritan Hospital Association, operating as Heart of America Medical Center, is dedicated to providing medical care regardless of a patient's financial situation. We offer comprehensive information about federal, state, and local payment assistance programs before services are rendered, or in emergency situations, as soon as it is appropriate.Our HAMC Community (Charity) Care program is available for inpatient and outpatient hospital services, clinic services, and swing bed care. Social work staff are on hand to provide patients with information about this program, which is also accessible on our website along with details about our Prompt Payment Discount program.Staff members who handle self-pay bills actively encourage patients to apply for Community Care, and our third-party collection company supports this effort by advising patients experiencing financial hardships to seek assistance through Community Care. |
| Part VI, Line 4: | Heart of America Medical Center (HAMC) is a 25-bed Critical Access Hospital and a designated Level V trauma center. The facility includes a chemotherapy/infusion suite, surgical suite, pharmacy, laboratory, and radiology services, including an on-site MRI. Outpatient services feature a wellness center, sports medicine, a pain clinic, and diabetes education.Located in Rugby, North Dakota, HAMC also encompasses a long-term care nursing home and Haaland Estates, a separate campus with 60 basic care beds, a memory care unit, and a 37-bed assisted living apartment building. The Heart of America Johnson Clinics are situated in Rugby, Dunseith, and Maddock, serving people within a 50-mile radius of Rugby. The nearest tertiary facility is 65 miles to the west.HAMC's primary service area includes Pierce County and parts of Benson, McHenry, Rolette, Wells, Towner, Sheridan, and Bottineau counties. According to the 2022 Community Health Needs Assessment, HAMC provides essential medical services to over 13,000 people in its service area. Employing around 280 staff members, HAMC is the region's largest employer and has a significant economic impact, with its annual payroll supporting additional jobs and income across various sectors of the local economy.Pierce County's population decreased by 8.8% from 4,359 in 2010 to 3,945 in 2022. Among the residents, 71% have insurance through employers, 13% are covered by Medicare, 12% are self-insured, 6% rely on Indian Health Services (IHS), 4% on Medicaid, 3% on Veterans Choice, 3% have no insurance, and 6% are covered by other means. Major employers in Rugby and Pierce County include HAMC, Rugby Manufacturing, and the public schools. |
| Part VI, Line 5: | Good Samaritan Hospital Association (GSHA) is supported by 14 member churches spread throughout our service area. The GSHA board of directors, who live in our primary service area and are engaged in various professions and activities, are elected by these member churches.Through the Heart of America Johnson Clinics, Heart of America Medical Center serves Rugby, Dunseith, and Maddock, ND, ensuring our patients receive healthcare services close to home. We offer specialty services in ophthalmology, podiatry, audiology, and mental health through partnerships with specialty clinics and providers. Additionally, we provide a shared OB service with Trinity, allowing patients to see their primary care provider for up to 30 weeks.Our state-of-the-art cancer treatment center features a chemotherapy suite, and we recently added life-saving 3D mammography equipment to our radiology department. Heart of America Hospice delivers personalized, holistic end-of-life care and services to local hospice patients and their families within a 60-mile radius of Rugby.Without GSHA, our community would lack essential services such as a hospital, 24-hour emergency room, rural health clinics, surgical clinic, skilled nursing care facility, basic care facility, assisted living facility, and a wellness/fitness center. We operate many of these programs at a loss, yet we continue to provide them to meet the needs of the people in our communities and service area.Providers applying to HAMC are granted privileges in our community once approved by the board of directors, as recommended by the medical staff during board meetings.To plan for our organization's future and ensure our community is prepared for ongoing changes in the healthcare model, we are committed to improving patient care facilities and upgrading medical equipment.As discussed above, GSHA offers comprehensive cancer treatments to our patients and communities, allowing them to stay closer to home during times of vulnerability. GSHA also operates a fully staffed ambulance department, addressing the community's need for emergency medical transport. Despite not being a cost-reimbursed service due to the proximity of other ambulance services in neighboring rural areas, our ambulance department fills a critical gap, responding to 592 total ambulance runs and 290 emergency (911) calls and conducted 166 transfers to tertiary facilities annually.To recruit and retain staff, GSHA participates in an education reimbursement program, which also attracts new families to Rugby. Additionally, GSHA provides a daycare fringe benefit, enabling parents to return to the workforce or remain employed after starting families, with the convenience of onsite daycare services.While being a community-minded organization has led to some financial inefficiencies, our commitment to serving the community remains steadfast. As the largest employer in the community and region, GSHA feels the pressure to offer extensive services and support, striving to meet and exceed community needs. |
| Part VI, Line 6: | GSHA operates independently as a Critical Access Hospital. Despite not being part of an affiliated healthcare system, we maintain robust partnerships through rural health network agreements with Trinity Medical Center in Minot and Sanford Bismarck in Bismarck, N.D. These agreements are designed to enhance our patients' continuity of care by establishing efficient referral processes and facilitating easy transfers between facilities. They also promote effective communication among healthcare providers.Additionally, GSHA is affiliated with Altru's in Grand Forks and utilizes the Epic Electronic Health Record (EHR) system. We are actively participating in the BCBS ACO and a Medicare ACO, ensuring that our patients receive optimal and coordinated care. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Ronald Skipper MD | ||||||||||||||
| Surgeon | $375,186 | $0 | $108 | $0 | $0 | $0 | $8,250 | $0 | $37,584 | $0 | $421,128 | $0 | $0 | $0 |
| Josalynne Hoff Rue MD | ||||||||||||||
| Physician | $309,008 | $0 | $7,155 | $0 | $1,632 | $0 | $6,678 | $0 | $39,690 | $0 | $364,163 | $0 | $0 | $0 |
| Chelsey Wyatt | ||||||||||||||
| CRNA | $296,008 | $0 | $54 | $0 | $2,555 | $0 | $7,138 | $0 | $43,153 | $0 | $348,908 | $0 | $0 | $0 |
| Steven Schoneberg MD | ||||||||||||||
| Physician | $277,184 | $0 | $7,421 | $0 | $0 | $0 | $7,148 | $0 | $34,723 | $0 | $326,476 | $0 | $0 | $0 |
| Cammy Kelsch FNP-C | ||||||||||||||
| ER Provider | $276,302 | $0 | $0 | $0 | $0 | $0 | $7,102 | $0 | $41,166 | $0 | $324,570 | $0 | $0 | $0 |
| Dustin Hager | ||||||||||||||
| COO & Provider | $198,196 | $0 | $3,800 | $0 | $0 | $0 | $5,287 | $0 | $41,883 | $0 | $249,166 | $0 | $0 | $0 |
| Erik Christenson | ||||||||||||||
| Secretary - CEO | $153,379 | $0 | $0 | $0 | $0 | $0 | $3,726 | $0 | $41,815 | $0 | $198,920 | $0 | $0 | $0 |
| Melissa Shepard | ||||||||||||||
| Treasurer - CFO | $134,584 | $0 | $2,554 | $0 | $0 | $0 | $3,444 | $0 | $13,000 | $0 | $153,582 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Sarah Christenson | |||
| Family member of CEO | $78,368 | Compensation | 0 |
| Lauren McClintock | |||
| Family member of CEO | $59,834 | Compensation | 0 |
| Scott Brossart | |||
| Family member of CEO | $68,800 | Compensation | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1a | The Executive Committee consists of all the Board of Trustees residing in the Rugby community plus the Chairman of the Board of Trustees. The Executive Committee shall have the power to transact all regular business of the hospital during the interim between meetings of the Board of Trustees and it shall refer to all matters of major importance to the Board. |
| Form 990, Part VI, Section A, line 6 | Membership in the corporation shall consist of such Lutheran congregations which are now members of this Association and such other congregations as shall from time to time apply for membership herein. The Congregational members of the Organization shall be represented by the following 4 specific designations: -4 From Rugby/Balta/Orrin -1 From Towner/Willow City -1 from Rolette/Wolford/Dunseith -1 from Leeds/Maddock The Board of Trustees shall also have at least one physician representative and, in its discretion, two members at large Trustees, one of whom shall have a background in legal or insurance and another who shall have a background in finance both of whom shall reside in the geographical region served by the Association. The physician representative shall be a non-voting representative appointed by the Board of Trustees. |
| Form 990, Part VI, Section A, line 7a | Each member church has up to three voting delegates at the annual meeting where the board of directors is elected to serve on the board. |
| Form 990, Part VI, Section A, line 7b | Amendments to the Articles of Incorporation must be voted on by a two-thirds majority vote of the members. Amendments to Bylaws must be voted on by a two-thirds majority vote of the Board of Trustees. |
| Form 990, Part VI, Section B, line 11b | The Board receives an electronic copy of the draft Form 990 prior to a board meeting to review. An overview of the 990 is provided as part of the financial summary for the Board during the actual board meeting to answer any questions they may have as well. A motion is made to approve the draft. |
| Form 990, Part VI, Section B, line 12c | Covered Persons: All employees, managers, medical staff, executive leadership, board members, volunteers, contractors, and others engaged in the work place. A conflict of Interest Statement must be signed by each board member and shall be dated no later than December 31st of each year. Determination of conflict: All employees and board members are required to disclose any actual or potential conflict of interest and seek guidance on how to handle the situation. Conflict review: Actual or potential board member conflicts of interest must be disclosed to the Corporate Compliance Committee (CCC). The CCC will handle reports or concerns of situations that may give rise to a conflict of interest with the assistance of legal counsel. The CCC will issue its decision to the Covered Persons in writing and will document and file its decision. Restrictions on those with a conflict: In self-dealing transactions the board member shall not participate in the board decision-making and shall make full disclosure of their interests. If the fairness of the transaction is questioned, the burden of establishing fairness falls upon the trustee involved and the board member must seek guidance and approval from the CCC prior to pursuing any business or personal activity that may constitute a conflict of interest. |
| Form 990, Part VI, Section B, line 15 | Comparative data is reviewed and incorporated into the review process such as looking at state wage survey data. For the CEO, each board member completes their own evaluation form. The human resource committee reviews the responses and makes a recommendation to the full board. The full board decides on any changes to CEO compensation. The review is done annually at time of anniversary date of contract. The board typically does not approve wages for other positions. The CEO approves the CFO wages. Comparative data is used throughout the facility and incorporated into the annual review of employee wages done by the department head or supervisor. Wages are compared to the NDHA annual salary survey report at the time of their annual review. |
| Form 990, Part VI, Section C, line 19 | These documents are available upon request. Financial statements are available for viewing by the public at all board meetings. |
| Form 990, Part VI, Line 16b: | The Organization is a 49% owner in a retail pharmacy located in the clinic building. The pharmacy bylaws requires an annual board meeting including representatives of the Hospital. The meeting evaluates the joint venture arrangement and assures the facility is not violating its tax exempt status. The pharmacy is organized and operating as a C-Corporation. |
| Form 990, Part IX, line 11g | Contracted Services: Program service expenses 2,887,725. Management and general expenses 112,426. Fundraising expenses 0. Total expenses 3,000,151. Other Fees: Program service expenses 129,621. Management and general expenses 335,016. Fundraising expenses 0. Total expenses 464,637. |
| Form 990, Part XI, line 9: | Change in interest in net assets of Foundation 65,080. Change in interest in net assets of Auxillary -32,713. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Health Services Foundation | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 South Main Ave | AddressLine1Txt |
| City | Rugby | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58368 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363513553 | EIN |
| Primary Activities | Fundraising for Good Samaritan Hospital Association | PrimaryActivitiesTxt |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 7 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Hospital Association | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Health Services Foundation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $923,173 | InvolvedAmt |
| Method Of Amount Determination | Accrual | MethodOfAmountDeterminationTxt |
Comments