PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION (EIN 45-6013474)
- Tax period
- 2023-01-01 to 2023-12-31
- Filed
- 2024-11-06
- IRS object ID
- 202443119349302584
- 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
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-11-06T13:30:59-06:00 | ReturnTs |
| Tax Period End | 2023-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 121 WEST BRIDGE STREET | AddressLine1Txt |
| City | OWATONNA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55060 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 456013474 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEMBINA COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Business Name Line2 | ASSOCIATION | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PEMB | BusinessNameControlTxt |
| Phone | 7012658461 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 301 MOUNTAIN STREET EAST | AddressLine1Txt |
| City | CAVALIER | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58220 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LISA LETEXIER | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7012658461 | PhoneNum |
| Signature | 2024-11-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JUSTIN HARTERT | PreparerPersonNm |
| PTIN | P02236744 | PTIN |
| Phone | 5074467100 | PhoneNum |
| Preparation | 2024-11-06 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2024-10-15 13:58:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | LISA LETEXIER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 301 MOUNTAIN STREET EAST | AddressLine1Txt |
| City | CAVALIER | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58220 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $21,422,108 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CAVALIERHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1976 | FormationYr |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE A FAMILY CENTERED APPROACH TO THE DELIVERY OF HEALTH SERVICES AND TO PROMOTE A HEALTHY LIFESTYLE FOR THOSE WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 199 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $871,996 | PYContributionsGrantsAmt |
| CY Contributions Grants | $271,830 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $19,750,390 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $20,951,579 | CYProgramServiceRevenueAmt |
| PY Investment Income | $12,262 | PYInvestmentIncomeAmt |
| CY Investment Income | $138,514 | CYInvestmentIncomeAmt |
| PY Other Revenue | $191,862 | PYOtherRevenueAmt |
| CY Other Revenue | $60,185 | CYOtherRevenueAmt |
| PY Total Revenue | $20,826,510 | PYTotalRevenueAmt |
| CY Total Revenue | $21,422,108 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | 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 | $9,489,922 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,939,799 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $105,969 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,601,271 | PYOtherExpensesAmt |
| CY Other Expenses | $10,591,815 | CYOtherExpensesAmt |
| PY Total Expenses | $19,091,193 | PYTotalExpensesAmt |
| CY Total Expenses | $20,531,614 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,735,317 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $890,494 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $20,778,796 | TotalAssetsBOYAmt |
| Total Assets EOY | $22,126,648 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,368,500 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,825,858 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $18,410,296 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $19,300,790 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF PEMBINA COUNTY MEMORIAL HOSPITAL AND WEDGEWOOD MANOR IS TO PROVIDE A FAMILY CENTERED APPROACH TO THE DELIVERY OF HEALTH SERVICES AND TO PROMOTE A HEALTHY LIFESTYLE TO THOSE WE SERVE IN CAVALIER AND THE SURROUNDING COMMUNITIES. THE VISION THAT GUIDES PEMBINA COUNTY MEMORIAL HOSPITAL AND WEDGEWOOD MANOR IS TO DEVELOP A FAMILY CENTERED INTEGRATED HEALTHCARE ORGANIZATION WHICH PROVIDES SERVICES THAT MEET THE NEEDS OF THE REGION, THEREBY MAKING US THEIR PROVIDER OF CHOICE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $18,037,752 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $20,951,579 | RevenueAmt |
| Desc | PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION IS A 20 BED ACUTE CARE HOSPITAL, 40 BED NURSING HOME, A RURAL HEALTH CLINIC, AND 20 UNIT CONGREGATE HOUSING COMPLEX LOCATED IN CAVALIER, ND. THE FACILITY PROVIDES QUALITY MEDICAL AND LONG-TERM CARE TO THE RESIDENTS OF THE SURROUNDING AREA, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES RECEIVED. A 24 HOUR EMERGENCY ROOM IS AVAILABLE FOR PATIENTS WHO NEED IMMEDIATE TREATMENT, AND TREATMENT IS PROVIDED TO ALL INDIVIDUALS WHO PRESENT, REGARDLESS OF THEIR ABILITY TO PAY. THE ASSOCIATION ALSO SUPPLIES FREE OR REDUCED SERVICES TO PATIENTS WHO MEET ESTABLISHED CRITERIA OUTLINED IN THE FACILITY'S CHARITY CARE POLICY AND PROVIDES HEALTH EDUCATION AND OTHER SERVICES TO THE COMMUNITY. | Desc |
| Total Program Service Expenses | $18,037,752 | 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 | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | Yes (1) | 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 | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 31 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 199 | 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 | 10 | 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 | 0 | 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 | KATIE WERNER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7012656281 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 301 MOUNTAIN ST E | AddressLine1Txt |
| City | CAVALIER | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58220 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 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 | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| DUANNE DERAAS | ||||||||
| PRESIDENT | 0.80 | 0.20 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| TOM VAUGHN | ||||||||
| VICE PRESIDENT | 0.80 | 0.20 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| GEORGE WRIGHT | ||||||||
| SECRETARY/TREASURER | 0.80 | 0.20 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| GORDON JOHNSON | ||||||||
| DIRECTOR | 0.80 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| NICOLE SAFRANSKI | ||||||||
| DIRECTOR | 0.80 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| SUSAN THOMPSON | ||||||||
| MEDICAL STAFF PRESIDENT | 40.00 | 0.00 | Yes (X) | Yes (X) | $222,533 | $0 | $30,908 | |
| DARIN OTTO | ||||||||
| DIRECTOR | 0.80 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| GRETTA BEARD | ||||||||
| DIRECTOR | 0.80 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| LARAE HORGAN | ||||||||
| DIRECTOR | 0.80 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| DREW OLAFSON | ||||||||
| DIRECTOR | 0.80 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| LISA LETEXIER | ||||||||
| CEO | 40.00 | 0.00 | Yes (X) | $189,871 | $0 | $22,541 | ||
| PATTI JOHNSON | ||||||||
| NURSING HOME ADMINISTRATOR | 40.00 | 0.00 | Yes (X) | $118,718 | $0 | $28,958 | ||
| KATIE WERNER | ||||||||
| CFO | 40.00 | 0.00 | Yes (X) | $92,677 | $0 | $40,544 | ||
| LAURA ERMER | ||||||||
| PHYSCIANS ASSISTANT | 40.00 | 0.00 | $175,065 | $0 | $9,246 | Yes (X) | ||
| JENNA CARPENTER | ||||||||
| NURSE PRACTITIONER | 40.00 | 0.00 | $168,979 | $0 | $9,126 | Yes (X) | ||
| KIM FORD | ||||||||
| NURSE PRACTITIONER | 40.00 | 0.00 | $160,688 | $0 | $10,431 | Yes (X) | ||
| HEATHER SNELL | ||||||||
| NURSE PRACTITIONER | 40.00 | 0.00 | $149,054 | $0 | $19,939 | Yes (X) | ||
| JANAE HEUCHERT | ||||||||
| PHARMACIST | 40.00 | 0.00 | $127,874 | $0 | $35,321 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,405,459 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $207,014 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | 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 |
|---|---|---|---|---|---|
| TRIAD TRAVEL NURSING | |||||
| 3155 BLUESTEM DR 115 | WEST FARGO | ND | 58078 | NURSING AGENCY | $611,722 |
| PARK RIVER CLINIC | |||||
| PO BOX 380 | CAVALIER | ND | 58220 | CONTRACT PHYSICIAN | $484,570 |
| DMS HEALTH TECHNOLOGIES | |||||
| PO BOX 670747 | DALLAS | TX | 752670747 | DIAGNOSTIC IMAGING SERVICES | $287,084 |
| ALTRU HEALTH SYSTEMS | |||||
| PO BOX 13780 | GRAND FORKS | ND | 582083780 | EMR MANAGEMENT SERVICES | $206,872 |
| MIDWEST RADIOLOGY | |||||
| PO BOX 2923 | INDIANAPOLIS | IN | 46206 | PROFESSIONAL RADIOLOGY SERVICES | $191,920 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $61,838 | GovernmentGrantsAmt |
| All Other Contributions | $209,992 | AllOtherContributionsAmt |
| Total Contributions | $271,830 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT REVENUE | 621110 | $18,134,697 | $18,134,697 |
| 340B REVENUE | 456110 | $2,624,796 | $2,624,796 |
| ANCILLARY REVENUES | 621110 | $192,086 | $192,086 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $20,951,579 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $138,514 | TotalRevenueColumnAmt |
| Exclusion | $138,514 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $15,991 | 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 | $15,991 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,991 | TotalRevenueColumnAmt |
| Exclusion | $15,991 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $44,194 | TotalRevenueColumnAmt |
| Exclusion | $44,194 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $44,194 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,422,108 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $20,951,579 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $198,699 | 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 | $746,750 | TotalAmt |
| Management And General | $746,750 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,687,661 | TotalAmt |
| Program Services | $6,803,271 | ProgramServicesAmt |
| Management And General | $823,294 | ManagementAndGeneralAmt |
| Fundraising | $61,096 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,926 | TotalAmt |
| Program Services | $104,199 | ProgramServicesAmt |
| Management And General | $10,609 | ManagementAndGeneralAmt |
| Fundraising | $1,118 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $834,518 | TotalAmt |
| Program Services | $750,100 | ProgramServicesAmt |
| Management And General | $76,373 | ManagementAndGeneralAmt |
| Fundraising | $8,045 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $554,944 | TotalAmt |
| Program Services | $498,807 | ProgramServicesAmt |
| Management And General | $50,787 | ManagementAndGeneralAmt |
| Fundraising | $5,350 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,083 | TotalAmt |
| Management And General | $5,083 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,581 | TotalAmt |
| Management And General | $81,581 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,040 | TotalAmt |
| Management And General | $2,040 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,742,945 | TotalAmt |
| Program Services | $4,589,768 | ProgramServicesAmt |
| Management And General | $147,060 | ManagementAndGeneralAmt |
| Fundraising | $6,117 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,018 | TotalAmt |
| Program Services | $11,916 | ProgramServicesAmt |
| Management And General | $41,321 | ManagementAndGeneralAmt |
| Fundraising | $2,781 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $218,146 | TotalAmt |
| Program Services | $211,010 | ProgramServicesAmt |
| Management And General | $6,855 | ManagementAndGeneralAmt |
| Fundraising | $281 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $397,049 | TotalAmt |
| Program Services | $322,627 | ProgramServicesAmt |
| Management And General | $74,422 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,689 | TotalAmt |
| Program Services | $28,689 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $803,296 | TotalAmt |
| Program Services | $803,296 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $146,980 | TotalAmt |
| Program Services | $31,265 | ProgramServicesAmt |
| Management And General | $108,418 | ManagementAndGeneralAmt |
| Fundraising | $7,297 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| MEDICAL SUPPLIES | $3,422,876 | $3,422,876 | ||
| EQUIPMENT RENTAL & REPA | $249,666 | $242,650 | $7,016 | $0 |
| FOOD EXPENSE | $195,702 | $41,628 | $144,358 | $9,716 |
| PROVISION FOR BAD DEBT | $149,054 | $149,054 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,690 | TotalAmt |
| Program Services | $26,596 | ProgramServicesAmt |
| Management And General | $61,926 | ManagementAndGeneralAmt |
| Fundraising | $4,168 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,531,614 | TotalAmt |
| Program Services | $18,037,752 | ProgramServicesAmt |
| Management And General | $2,387,893 | ManagementAndGeneralAmt |
| Fundraising | $105,969 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,350 | BOYAmt |
| EOY | $10,358 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,504,127 | BOYAmt |
| EOY | $6,970,236 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,950,713 | BOYAmt |
| EOY | $3,049,472 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $318,566 | BOYAmt |
| EOY | $209,387 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $142,400 | BOYAmt |
| EOY | $228,963 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $27,221,673 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $17,301,197 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,249,451 | BOYAmt |
| EOY | $9,920,476 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,603,189 | BOYAmt |
| EOY | $1,169,092 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $568,664 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,778,796 | BOYAmt |
| EOY | $22,126,648 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,647,912 | BOYAmt |
| EOY | $2,230,515 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,906 | BOYAmt |
| EOY | $10,001 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,310 | BOYAmt |
| EOY | $13,310 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $259,304 | BOYAmt |
| EOY | $219,778 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $267,434 | BOYAmt |
| EOY | $231,777 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $155,634 | BOYAmt |
| EOY | $120,477 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,368,500 | BOYAmt |
| EOY | $2,825,858 | 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 | $18,410,296 | BOYAmt |
| EOY | $19,300,790 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,410,296 | BOYAmt |
| EOY | $19,300,790 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,778,796 | BOYAmt |
| EOY | $22,126,648 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $890,494 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | 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 | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $2,040 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,040 | 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 | PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION PAYS ANNUAL DUES TO THE NORTH DAKOTA LONG-TERM CARE ASSOCIATION. A PORTION OF THOSE DUES ARE USED BY THE ASSOCIATION TO CONDUCT LOBBYING ON BEHALF OF ALL MEMBER HOSPITALS. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $4,919 | BeginningBalanceAmt |
| Additions During Year | $4,367 | AdditionsDuringYearAmt |
| Distributions During Year | $3,090 | DistributionsDuringYearAmt |
| Ending Balance | $6,196 | 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 | $160,304 | OtherCostOrOtherBasisAmt |
| Book Value | $160,304 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,383,415 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,236,599 | DepreciationAmt |
| Book Value | $3,146,816 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,168,399 | OtherCostOrOtherBasisAmt |
| Depreciation | $672,184 | DepreciationAmt |
| Book Value | $496,215 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,885,762 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,392,414 | DepreciationAmt |
| Book Value | $2,493,348 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,623,793 | OtherCostOrOtherBasisAmt |
| Book Value | $3,623,793 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,920,476 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ROU LEASE LIABILITY | Desc |
| Amt | $120,477 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $120,477 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $21,264,316 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $21,264,316 | RevenueSubtotalAmt |
| Other Revenues Not Included | $157,792 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $157,792 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $21,422,108 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $20,373,822 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $20,373,822 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $157,792 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $157,792 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $20,531,614 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, LINE 1B: | A SMALL AUXILIARY OPERATES UNDER THE HOSPITAL'S EIN. |
| PART IV, LINE 2B: | THE ASSOCIATION HOLDS FUNDS UNDER AN AGENCY RELATIONSHIP FOR THE RESIDENTS OF WEDGEWOOD MANOR AND COUNTRY ESTATES. THE FUNDS ARE SHOWN AS CASH AND A CORRESPONDING LIABILITY IN ACCOUNTS PAYABLE IN THE ACCOMPANYING BALANCE SHEETS. FUNDS HELD AS OF DECEMBER 31, 2023 AND 2022 TOTALED $13,310 AND $13,310 RESPECTIVELY. |
| PART X, LINE 2: | THE ASSOCIATION IS CLASSIFIED BY THE INTERNAL REVENUE SERVICE AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS SUBJECTED TO FEDERAL INCOME TAX ONLY ON NET UNRELATED BUSINESS INCOME. THE ASSOCIATION FOLLOWS GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE ASSOCIATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE APPLICATION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 149,054. CHARITY CARE 8,738. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 149,054. CHARITY CARE 8,738. |
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 |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | 0 | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,437 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,437 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,725,897 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,967,670 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,732,334 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,967,670 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,437 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $101,536 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $101,536 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00490 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,336,644 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,418,316 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $918,328 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04470 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,439,180 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,418,316 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,020,864 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04960 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,171,514 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,385,986 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,027,301 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04990 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $700 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $700 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $700 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $700 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $149,054 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $11,328 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,181,220 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,281,132 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$99,912 | 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 | 2 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEMBINA COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 301 MOUNTAIN STREET EAST | AddressLine1Txt |
| City | CAVALIER | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58220 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.CAVALIERHOSPITAL.COM | WebsiteAddressTxt |
| State License | 5009 | 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 | PEMBINA COUNTY MEMORIAL HOSPITAL | 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 | 23 | 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 | SEE PART V, SECTION B, LINE 7D | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 23 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION B, LINE 7D | 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 | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| 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 | HTTP://WWW.CAVALIERHOSPITAL.COM/HOW-TO-HELP/RESOURCES.HTML | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://WWW.CAVALIERHOSPITAL.COM/HOW-TO-HELP/RESOURCES.HTML | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://WWW.CAVALIERHOSPITAL.COM/HOW-TO-HELP/RESOURCES.HTML | 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 (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PEMBINA COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: IN 2023, PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION TOOK A PROACTIVE APPROACH TO IDENTIFYING THE NEEDS OF OUR COMMUNITY BY PARTICIPATING IN A COMMUNITY HEALTH NEEDS ASSESSMENT IN COLLABORATION WITH PEMBINA COUNTY PUBLIC HEALTH. THE ASSESSMENT WAS FACILITATED BY THE CENTER FOR RURAL HEALTH (UND SCHOOL OF MEDICINE & HEALTH SCIENCES).THIRTEEN COMMUNITY MEMBERS REPRESENTED SEVENTEEN COMMUNITIES SERVED BY PCMHA INCLUDING REPRESENTATIVES OF THE HEALTH COMMUNITY, BUSINESS COMMUNITY, POLITICAL BODIES, LAW ENFORCEMENT, FAITH COMMUNITY, AND AGRICULTURE COMMUNITIES. MEMBERS WERE INTRODUCED TO THE NEEDS ASSESSMENT PROCESS, REVIEWED BASIC DEMOGRAPHIC INFORMAATION AND SERVED AS A FOCUS GROUP. SURVEYS WERE DISTRIBUTED TO THE COMMUNITY AT LARGE TO COLLECT QUALITATIVE DATA INCLUDING INFORMATION RELATED TO COMMUNITY-PERCEIVED HEALTH NEEDS. SIXTY COMMUNITY MEMBERS COMPLETED THE SURVEY IN THE COMMUNITIES THROUGHOUT THE COUNTIES IN THE PCMHA SERVICE AREA. INTERVIEWS WERE ALSO CONDUCTED. |
| PEMBINA COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6B: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN COLLABORATION WITH PEMBINA COUNTY PUBLIC HEALTH AND WAS FACILITATED BY THE CENTER FOR RURAL HEALTH. |
| PEMBINA COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 7D: THE ORGANIZATION'S COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT HTTPS://WWW.CAVALIERHOSPITAL.COM/HOW-TO-HELP/RESOURCES.HTML. |
| PEMBINA COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: AN IMPLEMENTATION PLAN HAS BEEN DEVELOPED BASED ON COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS CONDUCTED IN 2023. THE CHNA WAS CONDUCTED IN COLLABORATION WITH PEMBINA COUNTY PUBLIC HEALTH TO DETERMINE THE MOST PRESSING HEALTH NEEDS OF PEMBINA COUNTY.THE TOP NEEDS IDENTIFIED IN THE CHNA PROCESS INCLUDES:-ALCOHOL USE AND ABUSE YOUTH AND ADULT-AVAILABILITY OF MENTAL HEALTH SERVICES-AVAILABILITY OF RESOURCES TO HELP THE ELDERLY STAY IN THEIR HOMES-AVAILABILITY OF VISION CARE-BULLYING/CYBERBULLYING-COST OF LONG-TERM/ NURSING HOME CARE-DEPRESSION/ ANXIETY YOUNG AND ADULT-HAVING ENOUGH AFFORDABLE HOUSING-SMOKING AND TOBACCO USE (SECOND-HAND SMOKE- YOUTH)THE PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION (PCMHA) BOARD OF DIRECTORS PRIORITIZED THE HEALTH NEEDS IDENTIFIED IN THE CHNA AND DEVELOPED AN IMPLEMENTATION STRATEGY FOR EACH SUCH NEED: PRIORITY AREA: AVAILABILITY OF MENTAL HEALTH SERVICES GOAL: INCREASE ACCESSIBILITY TO BEHAVIORAL HEALTH SERVICESSTRATEGIES:1. CONTINUE TO SUPPORT AND PROMOTE THE CURRENT MEDICAL HEALTH PROVIDERS SERVICES AT CLINICARE AND SEEK ANY OPPORTUNITY TO EXPAND SERVICES IF A VIABLE OPTION IS AVAILABLE.2. ENCOURAGE ATTENDANCE AND CONTINUE TO SUPPORT LOCAL LED SUPPORT GROUPS. SEEK OPPORTUNITIES TO EXPAND SUCH GROUPS.3. CONTINUE TO COLLABORATE WITH PEMBINA COUNTY BEHAVIORAL HEALTH COALITION (PCBHC) TO BRING EDUCATION, CLASSES, SPEAKERS, PROGRAMS, AND AWARENESS TO OUR COMMUNITIES.PRIORITY AREA: ALCOHOL USE & ABUSE, DEPRESSION/ ANXIETY YOUNG AND ADULTGOAL: INCREASE ACCESSIBILITY TO TREATMENT FOR DEPRESSION AND ANXIETY AND PROMOTE DANGERS OF ALCOHOL USE BY OUR YOUTH AND ADULTS.STRATEGIES:1. CONTINUE TO SUPPORT AND PROMOTE THE CURRENT MEDICAL HEALTH PROVIDERS SERVICES AT CLINICARE IN PERSON AND TELETHERAPY AND SEEK ANY VIABLE OPPORTUNITIES TO EXPAND SERVICES AS AVAILABLE.2. SUPPORT YOUTH AND ADULT ALCOHOL FREE ACTIVITIES AND EDUCATION WITHIN OUR COMMUNITIES.3. CONTINUE TO PROVIDE SPACE FOR SUPPORT GROUPS TO MEET AT PEMBINA COUNTY MEMORIAL HOSPITAL.PRIORITY AREA: AVAILABILITY OF RESOURCES TO HELP THE ELDERLY STAY IN THEIR HOMES GOAL: INCREASE ACCESS AND AWARENESS TO RESOURCES, SERVICES AND PROGRAMS TO ALLOW ELDERLY TO STAY IN THEIR HOMES LONGER.STRATEGIES:1. CONTINUE TO SUPPORT AND PROMOTE THE BONE BUILDERS CLASS THAT IS OFFERED WEEKLY TO THIS POPULATION.2. CONTINUE TO SUPPORT AND PROMOTE ACCESS TO THE PRESCRIPTION ASSISTANCE PROGRAM AND OTHER MEDICATION PROGRAMS.3. CONTINUE TO WORK WITH PEMBINA COUNTY HEALTH COALITION TO PROVIDE AND DISTRIBUTE A RESOURCE GUIDE FOR PEMBINA COUNTY OF SERVICES OFFERED.4. COLLABORATE WITH NDSU, PEMBINA COUNTY MEALS AND TRANSPORTATION, SOCIAL SERVICES AND OFFERING SERVICES TO PROGRAMS SUCH AS QSP AND SENIOR MEALS.PRIORITY AREA: SMOKING AND TOBACCO USE GOAL: GOAL: INCREASE ACCESSIBILITY TO TREATMENT FOR QUITTING SMOKING AND USING TOBACCO.STRATEGIES:1. CONTINUE TO SUPPORT AND PROMOTE THE CURRENT MEDICAL HEALTH PROVIDERS SERVICES AT CLINICARE AND SEEK ANY VIABLE OPPORTUNITIES TO EXPAND SERVICES AS AVAILABLE.2. SUPPORT YOUTH AND ADULT TOBACCO FREE ACTIVITIES AND EDUCATION WITHIN OUR COMMUNITIES.3. CONTINUE TO OFFER AND PROMOTE SUPPORTIVE MEDICATIONS AND EDUCATION ON RISKS OF SMOKING, VAPING AND TOBACCO USE.OTHER NEEDS IDENTIFIED IN THE CHNA, BUT NOT ADDRESSED IN THIS IMPLEMENTATION PLAN:1. AVAILABILITY OF VISION CARE- PCMHA WOULD BE AN ACTIVE PARTICIPANT IN COMMUNITY EFFORTS TO HELP IN THIS SERVICE BUT HAVEEXHAUSTED SOLO EFFORTS THAT WERE CURRENTLY AVAILABLE.2. BULLYING/CYBERBULLYING- PCMHA WILL PROMOTE EDUCATION AND EFFORTS TOWARDS THIS ISSUE AND WILL CONTINUE TO SUPPORT EFFORTS MADE ON THIS ISSUE.3. COST OF LONG-TERM/NURSING HOME CARE- PCMHA PROVIDES ONGOING FEEDBACK TO GOVERNMENT POLICYMAKERS AT THE STATE AND FEDERAL LEVEL AS THESE RATES ARE CALCULATED BY THEM FOR ALL INSTITUTIONS.- COLLABORATION AND REFERRALS TO COUNTY SOCIAL SERVICES OCCUR ON A REGULAR BASIS.- HOSPITAL AND NURSING HOME SOCIAL WORK DESIGNEES ARE AVAILABLE TO ASSIST INDIVIDUALS WHO LACK HEALTH INSURANCE THROUGH PROGRAMS OFFERED AND OUR FINANCIAL ASSISTANCE PROGRAM4. HAVING ENOUGH AFFORDABLE HOUSING- PCMHA IS PARTICIPATING WITH COMMUNITY LED EFFORTS TO DEVELOP MORE AFFORDABLE HOUSING WITHIN ITS SERVICE AREA- PCMHA IS A STEERING COMMITTEE PARTICIPANT ON A REGIONAL HOUSING STUDY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - WEDGEWOOD MANOR | ||||
| 804 MAIN STREET WEST | CAVALIER | ND | 58220 | SKILLED NURSING HOME |
| 2 - CLINICARE | ||||
| 301 MOUNTAIN STREET EAST | CAVALIER | ND | 58220 | RURAL HEALTH CLINIC |
| 3 - COUNTRY ESTATES | ||||
| 107 BJORNSON DRIVE | CAVALIER | ND | 58220 | CONGREGATE HOUSING |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | IN ADDITION TO LOOKING AT THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS, SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY ARE CONSIDERED. |
| PART I, LINE 7: | THE COMMUNITY BENEFIT AMOUNTS REPORTED ON LINES 7A AND 7B WERE CALCULATED USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE IRS FORM 990 INSTRUCTIONS. THE COMMUNITY BENEFIT AMOUNTS REPORTED ON LINES 7E-7I WERE THE DIRECT COSTS TO THE HOSPITAL. |
| PART I, LINE 7G: | SUBSIDIZED HEALTH SERVICES INCLUDED ON LINE 7G INCLUDE THE FOLLOWING DEPARTMENTS OF THE HOSPITAL THAT HAVE A COST TO CHARGE RATIO GREATER THAN 1 AS IDENTIFIED ON THE MEDICARE COST REPORT. THESE INCLUDE ADULTS AND PEDIATRICS, DIABETIC EDUCATION, SKILLED NURSING FACILITY, OPERATING ROOM, AND EMERGENCY ROOM. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | PCMH PARTICIPATES IN THE COMMUNITY HEALTH NEEDS ASSESSMENT EVERY 3 YEARS AND USE THIS TOOL TO FOCUS ON NEEDS IDENTIFIED BY THE COMMUNITIES WE SERVE. IN RESPONSE TO THE NEEDS IDENTIFIED, WE PROVIDE VARIOUS EDUCATION AND SHARE VALUABLE KNOWLEDGE FROM OUR PROVIDERS WITH THE COMMUNITY THRU OUTREACH PROGRAMS. IN ADDITION, WE MAKE SURE WE ESTABLISH PARTNERSHIPS WITH OTHER HEALTH FOCUSED GROUPS SUCH AS PEMBINA COUNTY PUBLIC HEALTH TO COLLABORATE AND EFFECTIVELY SHARE OUR MISSION TO DELIVER QUALITY HEALTH SERVICES. |
| PART III, LINE 2: | IN CALCULATING BAD DEBT EXPENSE, THE ORGANIZATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE. |
| PART III, LINE 3: | 7.6% OF THE INDIVIDUALS IN PEMBINA COUNTY FALL BELOW THE FEDERAL POVERTY LEVELS ACCORDING TO THE 2020 CENSUS DATA. CARE IS GIVEN TO INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY AND IF THE INDIVIDUAL'S FAMILY SIZE AND INCOME ARE BELOW THE FEDERAL POVERTY GUIDELINES THEN THEY WOULD BE ELIGIBLE FOR 100% CHARITY CARE ALLOWANCE. THEREFORE THE ORGANIZATION ESTIMATES THAT 7.6% OF THE BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. THIS IS A COMMUNITY BENEFIT AND A REASONABLE ESTIMATE BASED ON THE DEMOGRAPHICS OF THE AREA THE ORGANIZATION SERVES. |
| PART III, LINE 4: | SEE THE "ACCOUNTS RECEIVABLE, ALLOWANCE FOR CREDIT LOSSES, AND CREDIT POLICY NOTE 1 ON PAGE 8 OF THE ATTACHED FINANCIAL STATEMENTS FOR INFORMATION REGARDING THE ORGANIZATION'S BAD DEBT EXPENSE. |
| PART III, LINE 8: | ALL OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT. THE ORGANIZATION TREATS INDIVIDUALS REGARDLESS OF ABILITY TO PAY. MOST OF THE MEDICARE SHORTFALL COMES FROM THE NURSING HOME. THE ELDERLY ARE AN UNDERSERVED POPULATION AND IT IS A COMMUNITY BENEFIT TO BE ABLE TO TREAT THEM AT THE LOCAL NURSING HOME.MEDICARE ALLOWABLE COSTS OF CARE ARE BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. |
| PART III, LINE 9B: | IF AN INDIVIDUAL SUBMITS A FINANCIAL ASSISTANCE APPLICATION, HOSPITAL SHALL CEASE ALL COLLECTION EFFORTS UNTIL A DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY IS MADE.IF HOSPITAL OR ANOTHER AUTHORIZED PARTY HAS ALREADY BEGUN AN EXTRAORDINARY COLLECTION ACTION AGAINST AN INDIVIDUAL WHEN THAT INDIVIDUAL SUBMITS A COMPLETE FINANCIAL ASSISTANCE APPLICATION, THE EXTRAORDINARY COLLECTION ACTION WILL BE SUSPENDED. SUSPENDING AN ACTION MEANS THAT NO FURTHER STEPS ARE TAKEN ON THAT EXTRAORDINARY COLLECTION ACTION AND NO NEW EXTRAORDINARY COLLECTION ACTIONS ARE INITIATED. THIS SUSPENSION MAY BE LIFTED WHEN HOSPITAL DETERMINES THE INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE AND NOTIFIES THE INDIVIDUAL AS PRESCRIBED IN THE FINANCIAL ASSISTANCE POLICY. IF HOSPITAL OR ANOTHER AUTHORIZED PARTY HAS ALREADY BEGUN AN EXTRAORDINARY COLLECTION ACTION AGAINST AN INDIVIDUAL WHEN THAT INDIVIDUAL IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, HOSPITAL AND/OR THE OTHER AUTHORIZED PARTY WILL TAKE ALL REASONABLY AVAILABLE MEASURES TO REVERSE THE EXTRAORDINARY COLLECTION ACTION. IF AN INDIVIDUAL SUBMITS AN INCOMPLETE FINANCIAL ASSISTANCE APPLICATION, HOSPITAL SHALL TAKE THE FOLLOWING STEPS TO ENCOURAGE THEM TO COMPLETE THE APPLICATION.1. SUSPEND ANY EXTRAORDINARY COLLECTION ACTIONS TO OBTAIN PAYMENT FOR THE CARE. 2. PROVIDE A WRITTEN NOTICE TO THE RESPONSIBLE PARTY THAT INCLUDES THE FOLLOWING INFORMATION. A. THE ADDITIONAL INFORMATION AND/OR DOCUMENTATION THAT MUST BE SUBMITTED. B. THE PHYSICAL LOCATION AND PHONE NUMBER OF A HOSPITAL EMPLOYEE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY. C. THE PHYSICAL LOCATION AND PHONE NUMBER OF AN ORGANIZATION OR HOSPITAL EMPLOYEE/OFFICE/DEPARTMENT THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. 3. ALLOW A REASONABLE AMOUNT OF TIME FOR THE RESPONSIBLE PARTY TO SUBMIT A COMPLETE FINANCIAL ASSISTANCE APPLICATION. SUCH PERIOD OF TIME SHALL BE AT LEAST 30 DAYS FROM THE DATE THE WRITTEN NOTICE IS SENT TO THE RESPONSIBLE PARTY. IF THE RESPONSIBLE PARTY FAILS TO PROVIDE THE REQUESTED INFORMATION WITHIN THE STATED TIME, HOSPITAL MAY RENEW THE PREVIOUSLY INITIATED EXTRAORDINARY COLLECTION ACTIONS. IF AN INDIVIDUAL HAS MADE FULL OR PARTIAL PAYMENT, AND THE INDIVIDUAL IS SUBSEQUENTLY DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE, ANY PAYMENTS IN EXCESS OF THEIR NEWLY CALCULATED REMAINING LIABILITY WILL BE REFUNDED TO THE PATIENT WITHIN 30 DAYS OF THE FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION. IF THE REFUNDABLE AMOUNT IS LESS THAN $1.00, IT WILL NOT BE REFUNDED. |
| PART VI, LINE 2: | PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION ASSESSES THE COMMUNITY'S HEALTH NEEDS AS FOLLOWS:1. REPRESENTATION ON THE COUNTY WIDE EMERGENCY SERVICES BOARD. 2. REPRESENTATION ON THE DOMESTIC VIOLENCE BOARD. 3. CONTINUED MEETINGS WITH PUBLIC HEALTH AND OTHER COMMUNITY REPRESENTATIVES REGARDING MENTAL HEALTH ISSUES. |
| PART VI, LINE 3: | NOTICES OF THE FAP ARE POSTED IN ALL WAITING AREAS, REGISTRATION AREAS, AND UPON DISCHARGE. WE PARTICIPATE IN THE HOSPITAL PRESUMPTIVE ELIGIBILITY (HPE) PROGRAM WHICH ALLOWS US TO ASSIST PATIENTS WITH IMMEDIATE ACCESS TO TEMPORARY ENROLLMENT IN MEDICAID WHILE APPLYING FOR PERMANENT COVERAGE. |
| PART VI, LINE 4: | PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION IS COMPRISED OF A 20-BED CRITICAL ACCESS HOSPITAL, 40-BED NURSING HOME (WEDGEWOOD MANOR), A 20-UNIT CONGREGATE HOUSING PROJECT (COUNTRY ESTATES), AND RURAL HEALTH CLINIC LOCATED IN CAVALIER, NORTH DAKOTA. PCMH IS LOCATED IN NORTHEASTERN NORTH DAKOTA, APPROXIMATELY 80 MILES NORTH OF GRAND FORKS AND 16 MILES FROM THE CANADIAN BORDER. ITS SERVICE AREA INCLUDES THE TOWNS OF BATHGATE, CAVALIER, CRYSTAL, DRAYTON, EDINBURG, GARDAR, GLASSTON, HAMILTON, HOOPLE, HENSEL, MILTON, MOUNTAIN, NECHE, OSNABROCK, PEMBINA, ST. THOMAS, AND WALHALLA, ALONG WITH THE ENTIRETY OF PEMBINA COUNTY.OUR ORGANIZATION SERVES PEMBINA COUNTY AND THE SURROUNDING REGION (THE NORTH EAST CORNER OF NORTH DAKOTA). THE US CENSUS FOR 2020 SHOWED A POPULATION OF 6,661 FOR PEMBINA COUNTY. THE MEDIAN INCOME FOR A HOUSEHOLD IN PEMBINA COUNTY WAS $64,243. THE PER CAPITA INCOME FOR THE COUNTY WAS $39,230. 9.6% OF THE POPULATION IS BELOW THE POVERTY LINE. WE ARE CONSIDERED A RURAL AREA; AGRICULTURE IS OUR MAIN INDUSTRY. WE ARE THE ONLY HOSPITAL IN PEMBINA COUNTY; CAVALIER AND WALSH COUNTIES (NEIGHBORING COUNTIES) ALSO HAVE MEDICAL FACILITIES. |
| PART VI, LINE 5: | THE MISSION OF PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION (PCMHA) IS TO PROVIDE A FAMILY CENTERED APPROACH TO THE DELIVERY OF HEALTH SERVICES AND TO PROMOTE A HEALTHY LIFESTYLE FOR THOSE WE SERVE. OUR KEY LEADERS AND VOLUNTEER BOARD MEMBERS ARE RESIDENTS WHO LIVE WITHIN THE AREAS WE SERVE. IN A RURAL SETTING, IT IS CRUCIAL TO BE INVOLVED IN THE HEALTH OF OUR COMMUNITY, SO PCMHA SUPPORTS AND PARTICIPATES IN INITIATIVES TO EDUCATE OUR COMMUNITY AT EVERY OPPORTUNITY. NOT ONLY DO WE PROMOTE HEALTHY LIFESTYLES AND EDUCATION ON TOPICS SUCH AS DIABETES, CARDIAC HEALTH, MENTAL/BEHAVIORAL HEALTH, AND BREASTFEEDING SUPPORT CLASSES WE ALSO PARTICIPATE IN SCRUBS CAMP TO EMPHASIZE THE IMPORTANCE OF VARIOUS HEALTHCARE PROFESSIONS TO OUR YOUTH TO ENCOURAGE AND PROMOTE INTEREST IN THE FIELDS OF MEDICINE. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SUSAN THOMPSON | ||||||||||||||
| MEDICAL STAFF PRESIDENT | $222,533 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $30,908 | $0 | $253,441 | $0 | $0 | $0 |
| LISA LETEXIER | ||||||||||||||
| CEO | $189,871 | $0 | $0 | $0 | $0 | $0 | $6,562 | $0 | $15,979 | $0 | $212,412 | $0 | $0 | $0 |
| LAURA ERMER | ||||||||||||||
| PHYSCIANS ASSISTANT | $175,065 | $0 | $0 | $0 | $0 | $0 | $7,019 | $0 | $2,227 | $0 | $184,311 | $0 | $0 | $0 |
| JENNA CARPENTER | ||||||||||||||
| NURSE PRACTITIONER | $168,979 | $0 | $0 | $0 | $0 | $0 | $6,772 | $0 | $2,354 | $0 | $178,105 | $0 | $0 | $0 |
| KIM FORD | ||||||||||||||
| NURSE PRACTITIONER | $160,688 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $10,431 | $0 | $171,119 | $0 | $0 | $0 |
| HEATHER SNELL | ||||||||||||||
| NURSE PRACTITIONER | $149,054 | $0 | $0 | $0 | $0 | $0 | $6,150 | $0 | $13,789 | $0 | $168,993 | $0 | $0 | $0 |
| JANAE HEUCHERT | ||||||||||||||
| PHARMACIST | $127,874 | $0 | $0 | $0 | $0 | $0 | $5,727 | $0 | $29,594 | $0 | $163,195 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PARK RIVER CLINIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | PARK RIVER CLINIC IS OWNED BY DR. KULVINDER SUMRA, A FORMER BOARD MEMBER | RelationshipDescriptionTxt |
| Transaction | $484,570 | TransactionAmt |
| Transaction | PAYMENT FOR DR. SUMRA'S PHYSICIAN SERVICES | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1A | THE EXECUTIVE COMMITTEE IS MADE UP OF THE PRESIDENT, VICE PRESIDENT, AND SECRETARY/TREASURER. THIS COMMITTEE SHALL HAVE THE FOLLOWING DUTIES AND DELEGATED RESPONSIBILITIES, SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD OF DIRECTORS: A) MEET AS NEEDED BETWEEN SCHEDULED BOARD MEETINGS AND TAKE ACTION AS REQUIRED ON BEHALF OF THE BOARD WHEN IT IS NOT FEASIBLE TO BRING THE FULL BOARD TOGETHER IN TIME TO ADDRESS AN ISSUE. ALL SUCH ACTIONS SHALL BE REPORTED TO THE BOARD AT THE NEXT REGULARLY SCHEDULED BOARD MEETING. B) MEET ON AN ANNUAL BASIS AND RECOMMEND TO THE BOARD APPROPRIATE COMPENSATION FOR THE ADMINISTRATOR/CHIEF EXECUTIVE OFFICER (CEO). C) REVIEW AT LEAST ANNUALLY AND MAKE RECOMMENDATIONS TO THE BOARD CONCERNING ANY NECESSARY CHANGES TO THESE BYLAWS. D) EVALUATE THE PERFORMANCE OF THE BOARD ON AN ANNUAL BASIS. E) PERFORM SUCH OTHER DUTIES AND RESPONSIBILITIES AS MAY BE ASSIGNED BY THE BOARD OF DIRECTORS TO THE COMMITTEE FROM TIME TO TIME. |
| FORM 990, PART VI, SECTION A, LINE 6 | ANY COMMUNITY MEMBER OR EMPLOYEE MAY PURCHASE STOCK WHICH GIVES THEM A VOTING RIGHT AT THE ANNUAL MEETING. THE CORPORATION SHALL ALWAYS MEET THE IRS COMMUNITY BOARD REQUIREMENTS FOR EXEMPTION FROM INCOME TAXATION - THE COMMUNITY BOARD IS ONE IN WHICH INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY COMPRISE A MAJORITY. NO EMPLOYEE OF THE CORPORATION, EXCEPT FOR MEMBERS MAINTAINING ACTIVE MEDICAL STAFF PRIVILEGES OF THE CORPORATION, SHALL BE ELIGIBLE FOR MEMBERSHIP ON THE BOARD BECAUSE OF THE PERCEIVED CONFLICT OF INTEREST. A MAJORITY OF THE BOARD SHALL CONSIST OF INDEPENDENT DIRECTORS. ONE (1) MEMBER OF THE BOARD SHALL BE AN EX-OFFICIO MEMBER APPOINTED BY ALTRU HEALTH SYSTEM FOR THE TERMS OF THE ALTRU/PCMHA AFFILIATION AGREEMENT. |
| FORM 990, PART VI, SECTION A, LINE 7A | ALL STOCKHOLDERS MAY VOTE AT THE ANNUAL MEETING WHEN BOARD MEMBERSHIP IS RENEWED AND NOMINATIONS ARE TAKEN. |
| FORM 990, PART VI, SECTION B, LINE 11B | A COMPLETE COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS VIA EMAIL FOR THEIR REVIEW PRIOR TO MEETING APPROVAL. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE PROCESS OF DISCLOSING THE CONFLICT OF INTEREST IS GONE THROUGH ANNUALLY. EACH BOARD MEMBER COMPLETES A FORM AND DISCLOSES IF THEY HAVE A CONFLICT OF INTEREST. THE CEO AND BOARD PRESIDENT REVIEW THE DISCLOSURE FORMS AND IF A CONFLICT RAISES AN ISSUE, IT IS BROUGHT TO THE FULL BOARD FOR DISCUSSION ON FURTHER ACTION (IF NECESSARY), WHICH MAY RESULT IN A CONSULTATION WITH AN ATTORNEY. IF THE BOARD IS VOTING ON AN ISSUE WHERE THERE IS A CONFLICT OF INTEREST, THE PERSON WITH THE CONFLICT OF INTEREST IS ASKED TO ABSTAIN FROM THE VOTE. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO'S COMPENSATION IS REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS. COMPARATIVE DATA IS GATHERED FROM THE ND HOSPITAL ASSOCIATION'S WAGE SURVEYS. A BLUE FORM IS GIVEN TO HR INDICATING ANY SALARY DECISIONS. THE CFO'S COMPENSATION IS REVIEWED ANNUALLY BY THE CEO. CHANGES TO THE CFO'S SALARY MAY BE BASED ON NORTH DAKOTA HOSPITAL ASSOCIATION SURVEYS OR OTHER INDUSTRY SURVEYS AND ALSO BUDGET APPROVAL BY THE BOARD OF DIRECTORS. FOR OTHERS, THE BOARD IS NOT INVOLVED IN THE FINAL COMPENSATION DECISION, BUT INSTEAD THE CEO AND CFO MAKE THE FINAL COMPENSATION DECISION. THIS PROCESS IS DONE ANNUALLY AND WAS LAST UNDERTAKEN IN 2023. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER FEES: PROGRAM SERVICE EXPENSES 4,589,768. MANAGEMENT AND GENERAL EXPENSES 147,060. FUNDRAISING EXPENSES 6,117. TOTAL EXPENSES 4,742,945. |
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