ASHLEY MEDICAL CENTER DBA AMC CLINIC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- ASHLEY MEDICAL CENTER DBA AMC CLINIC (EIN 45-0255914)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-02-22
- IRS object ID
- 202300539349301255
- Schema version
- 2021v4.2
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-02-22T12:41:48-06:00 | ReturnTs |
| Tax Period End | 2022-06-30 | 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 | 1730 Burnt Boat Loop Ste 100 | AddressLine1Txt |
| City | Bismarck | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 585030886 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450255914 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Ashley Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ASHL | BusinessNameControlTxt |
| Phone | 7012883433 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 450 612 Center Ave N | AddressLine1Txt |
| City | Ashley | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 584130450 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Eric Heupel | PersonNm |
| Person Title | Administrator | PersonTitleTxt |
| Phone | 7012883433 | PhoneNum |
| Signature | 2023-02-22 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Eric | PersonFirstNm |
| Person Last | Heupel | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Lisa Chaffee CPA | PreparerPersonNm |
| PTIN | P00193453 | PTIN |
| Phone | 7012551091 | PhoneNum |
| Preparation | 2023-02-22 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-03-07 01:45:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Jerry Lepp | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 450 612 Center Ave N | AddressLine1Txt |
| City | Ashley | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 584130450 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $10,168,498 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | amctoday.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1952 | FormationYr |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Activity Or Mission | To construct, maintain, and operate health care facilities in the community of Ashley, ND. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 141 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,564,396 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,581,254 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $7,830,625 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $8,556,514 | CYProgramServiceRevenueAmt |
| PY Investment Income | $9,587 | PYInvestmentIncomeAmt |
| CY Investment Income | $25,000 | CYInvestmentIncomeAmt |
| PY Other Revenue | $5,880 | PYOtherRevenueAmt |
| CY Other Revenue | $5,730 | CYOtherRevenueAmt |
| PY Total Revenue | $11,410,488 | PYTotalRevenueAmt |
| CY Total Revenue | $10,168,498 | 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 | $5,814,572 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,809,692 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,776,927 | PYOtherExpensesAmt |
| CY Other Expenses | $3,473,034 | CYOtherExpensesAmt |
| PY Total Expenses | $8,591,499 | PYTotalExpensesAmt |
| CY Total Expenses | $9,282,726 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,818,989 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $885,772 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $8,455,161 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,132,494 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,092,498 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,912,805 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,362,663 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,219,689 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Ashley Medical Center is a community organization which provides preventative, curative, supportive and educational health care that meets the physical, emotional, and spiritual needs of the people we serve. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $4,972,610 | ExpenseAmt |
| Revenue | $4,799,348 | RevenueAmt |
| Desc | Acute health care consisting of inpatient days of 201, outpatient hours of 1,519 and swing bed days of 480. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,724,042 | ExpenseAmt |
| Revenue | $2,708,578 | RevenueAmt |
| Desc | Long term skilled care for the frail and elderly total resident days of 8,936. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,317,616 | ExpenseAmt |
| Revenue | $877,621 | RevenueAmt |
| Desc | Rural Health Clinic Services with 3,249 clinic visits. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $97,827 | ExpenseAmt |
| Revenue | $170,967 | RevenueAmt |
| Desc | Other program services include apartment space to the elderly and low income under business code 721310. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $97,827 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $170,967 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $8,112,095 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 | 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 | 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 | 36 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 141 | 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 | 8 | 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 | Jerry Lepp CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7012883433 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 612 Center Ave N | AddressLine1Txt |
| City | Ashley | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 584130450 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Polly Wyrick Ulrich | |||||||
| President | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Brenda Meyer Vice President | |||||||
| (Nov-Jun)/Board member (Jul-Oct) | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Kristie Schnabel | |||||||
| Vice President (thru Oct) | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Candace Nies | |||||||
| Secretary | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Sherrece Golz | |||||||
| Board Member | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| JoAnne Stugelmayer | |||||||
| Board Member | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Anthony Neu | |||||||
| Board Member | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Megan Thomas | |||||||
| Board Member | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Shane Peacock | |||||||
| Board Member (as of Oct) | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Kristie Morrison | |||||||
| Board Member (as of Feb) | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Michael Schlepp | |||||||
| Board Member (Jul-Feb) | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Jerry Lepp | |||||||
| CFO | 32.00 | Yes (X) | $72,158 | $0 | $29,145 | ||
| Eric Heupel | |||||||
| Administrator | 40.00 | Yes (X) | $119,794 | $0 | $12,860 | ||
| Lori Bichler | |||||||
| Nurse Practitioner | 40.00 | $216,553 | $0 | $17,822 | Yes (X) | ||
| Jeremy St Aubin | |||||||
| Physical Terapist | 40.00 | $114,573 | $0 | $22,449 | Yes (X) | ||
| Tara Brandner | |||||||
| Nurse Practitioner | 40.00 | $112,454 | $0 | $10,452 | Yes (X) | ||
| Cori Randall | |||||||
| Nurse Practitioner | 40.00 | $102,264 | $0 | $23,892 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $737,796 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $116,620 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Sanford Health | |||||
| PO Box 2010 | Fargo | ND | 58122 | Medical Director | $118,336 |
| Homestead Recruiters Inc | |||||
| 821 Senior Ave | Dickinson | ND | 58601 | Temp Nursing | $117,850 |
| West Dakota Medical Services LLC | |||||
| 10710 Rose Dr | Bismarck | ND | 58503 | Locum Provider Services | $110,185 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,520,964 | GovernmentGrantsAmt |
| All Other Contributions | $60,290 | AllOtherContributionsAmt |
| Total Contributions | $1,581,254 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Net Patient Revenue | Desc |
| Business | 623000 | BusinessCd |
| Total Revenue Column | $8,464,245 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,464,245 | RelatedOrExemptFuncIncomeAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $92,269 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $92,269 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $8,556,514 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $5,730 | 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 | $5,730 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,730 | TotalRevenueColumnAmt |
| Exclusion | $5,730 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $25,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $25,000 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,000 | TotalRevenueColumnAmt |
| Exclusion | $25,000 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,168,498 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,556,514 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $30,730 | 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 | $283,368 | TotalAmt |
| Management And General | $283,368 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,584 | TotalAmt |
| Management And General | $111,584 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,291,947 | TotalAmt |
| Program Services | $4,150,946 | ProgramServicesAmt |
| Management And General | $141,001 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,389 | TotalAmt |
| Program Services | $108,226 | ProgramServicesAmt |
| Management And General | $3,163 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $696,340 | TotalAmt |
| Program Services | $662,068 | ProgramServicesAmt |
| Management And General | $34,272 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $315,064 | TotalAmt |
| Program Services | $282,186 | ProgramServicesAmt |
| Management And General | $32,878 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,313 | TotalAmt |
| Management And General | $50,313 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,282,419 | TotalAmt |
| Program Services | $1,150,689 | ProgramServicesAmt |
| Management And General | $131,730 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,696 | TotalAmt |
| Program Services | $20,144 | ProgramServicesAmt |
| Management And General | $12,552 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $156,505 | TotalAmt |
| Program Services | $111,187 | ProgramServicesAmt |
| Management And General | $45,318 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $231,693 | TotalAmt |
| Program Services | $227,070 | ProgramServicesAmt |
| Management And General | $4,623 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,093 | TotalAmt |
| Program Services | $73,639 | ProgramServicesAmt |
| Management And General | $30,454 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,785 | TotalAmt |
| Program Services | $20,823 | ProgramServicesAmt |
| Management And General | $12,962 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,113 | TotalAmt |
| Program Services | $11,290 | ProgramServicesAmt |
| Management And General | $823 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $311,704 | TotalAmt |
| Program Services | $290,516 | ProgramServicesAmt |
| Management And General | $21,188 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,923 | TotalAmt |
| Program Services | $7,228 | ProgramServicesAmt |
| Management And General | $73,695 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $685,014 | $679,948 | $5,066 |
| Maintenance and Repairs | $350,719 | $200,499 | $150,220 |
| Equipment Rentals | $81,780 | $81,780 | |
| Rentals | $7,595 | $7,595 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,682 | TotalAmt |
| Program Services | $33,856 | ProgramServicesAmt |
| Management And General | $17,826 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,282,726 | TotalAmt |
| Program Services | $8,112,095 | ProgramServicesAmt |
| Management And General | $1,170,631 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $224 | BOYAmt |
| EOY | $224 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,910,254 | BOYAmt |
| EOY | $3,894,884 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $906,100 | BOYAmt |
| EOY | $946,052 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $153,759 | BOYAmt |
| EOY | $167,510 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,486 | BOYAmt |
| EOY | $87,898 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $9,142,704 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,344,580 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,708,158 | BOYAmt |
| EOY | $1,798,124 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $222,501 | BOYAmt |
| EOY | $193,802 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $471,679 | BOYAmt |
| EOY | $44,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,455,161 | BOYAmt |
| EOY | $7,132,494 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $771,440 | BOYAmt |
| EOY | $778,051 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,786,341 | BOYAmt |
| EOY | $754,099 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,054 | BOYAmt |
| EOY | $10,587 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $376,441 | BOYAmt |
| EOY | $326,290 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,092,367 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $54,855 | BOYAmt |
| EOY | $43,778 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,092,498 | BOYAmt |
| EOY | $1,912,805 | 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 | $4,307,508 | BOYAmt |
| EOY | $5,164,534 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,155 | BOYAmt |
| EOY | $55,155 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,362,663 | BOYAmt |
| EOY | $5,219,689 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,455,161 | BOYAmt |
| EOY | $7,132,494 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $885,772 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$28,746 | NetUnrlzdGainsLossesInvstAmt |
| 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 D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| 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 | $25,001 | OtherCostOrOtherBasisAmt |
| Book Value | $25,001 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $77,390 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $5,456,037 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,757,494 | DepreciationAmt |
| Book Value | $775,933 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,292,434 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,587,086 | DepreciationAmt |
| Book Value | $705,348 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $291,842 | OtherCostOrOtherBasisAmt |
| Book Value | $291,842 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,798,124 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Capital Lease | Desc |
| Amt | $43,778 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $43,778 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $10,139,752 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$28,746 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$28,746 | RevenueNotReportedAmt |
| Revenue Subtotal | $10,168,498 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $10,168,498 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $9,282,726 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $9,282,726 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $9,282,726 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 2b: | The Medical Center acts as custodian for the funds of the residents and holds security deposits for the apartments. These funds are included in cash and cash equivalents and accounts payable in the accompanying balance sheets. |
| Part X, Line 2: | The Medical Center believes it has appropriate support for any tax positions taken affecting the annual filing requirements for the Medical Center, and as such, does not have any uncertain tax positions that are material to the financial statements. The Medical Center would recognize future accrued interest and penalties related to unrecognized tax liabilities in income tax expense if such interest and penalties are incurred. |
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 | 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 | $6,371 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,371 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,586,044 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,467,349 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $118,695 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01280 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,592,415 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,467,349 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $125,066 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01350 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $77,976 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,507 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $62,469 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00670 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $91,779 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $47,430 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $44,349 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00480 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $169,755 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $62,937 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $106,818 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01150 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,762,170 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,530,286 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $231,884 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02500 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $229,200 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $22,920 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,454,778 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,435,754 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $19,024 | 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 | Ashley Medical Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 450 612 Center Avenue North | AddressLine1Txt |
| City | Ashley | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 584130450 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | amctoday.org | WebsiteAddressTxt |
| State License | 5001 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room Other | Yes (X) | EmergencyRoomOtherInd |
| Other | Swingbed | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Ashley 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 | http://amctoday.org/services | 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 | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | http://amctoday.org/services | 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 |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| 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://amctoday.org/services | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://amctoday.org/services | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://amctoday.org/services | 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 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 |
|---|---|
| Ashley Medical Center | Part V, Section B, Line 5: To gather feedback from the community, residents of the area were given the opportunity to participate in a survey, from November 22nd to December 16th, 2021. Thirty-nine AMC service area residents completed the survey. Additional information was collected through six key informant interviews with community members conducted November 22, 2021. The input from the residents, who primarily reside in McIntosh County, represented the broad interests of the communities in the service area. Together with secondary data gathered from a wide range of sources, the survey presents a snapshot of the health needs and concerns in the community |
| Ashley Medical Center | Part V, Section B, Line 6b: McIntosh County Public Health assisted with the assessment. |
| Ashley Medical Center | Part V, Section B, Line 7d: Copies were left at our municipal offices downtown. |
| Ashley Medical Center | Part V, Section B, Line 11: The top four priorities identified in our 6/30/2022 CHNA were:*Depression/Anxiety in youth and adults*Having enough child daycare services*Assisted living options*Ability to recruit and retain a primary care providersThe hospital will not address the first two needs identified. Depression/Anxiety in youth and adults is a matter the Ashley Medical Center feels we do not have a lot of control over. We will try to combat this by promoting living a healthy lifestyle and by bringing awareness to this issue. The CHNA took place prior to a new daycare opening. This eliminated the preexisting need of adequate childcare.The assisted living option is on the Ashley Medical Centers radar. This is something that is in our future plans. We have eight independent living apartments that we are in the process of converting into assisted living apartments. We are currently renovating each apartment as they become vacant. We hope to be able to meet this need in the near future.The Ashley Medical Center is trying to solve the issue of recruiting and retaining a primary care provider by continuing to recruit and retain primary care providers. We offer competitive wages with the surrounding communities. This is something we will continue to monitor. We also have many active volunteers participating in community organizations that are aimed at supporting and building a better community. We will continue to support the volunteers that are a part of this organization, as well the organizations themselves. |
| 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 - Ashley Medical Center SNF | ||||
| 612 Center Ave N | Ashley | ND | 584130450 | Long Term Care Facility |
| 2 - AMC Clinic Ashley | ||||
| 612 Center Ave N | Ashley | ND | 584130450 | Rural Health Clinic |
| 3 - AMC Clinic Zeeland | ||||
| 203 South Main | Zeeland | ND | 58581 | Rural Health Clinic |
Supplemental Information Detail SupplementalInformationDetail (10 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, is actual costs reported in the general ledger. The cost for medicaid on line 7b and subsidized health services reported on line 7g were determined using 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 reasonably estimates the portion of implicit price concessions that could have qualified for charity care based on historical data. An estimated 10% of implicit price concessions in 2021 are attributable to patients potentially eligible for charity care. |
| Part III, Line 4: | The financial statement footnote regarding implicit price concessions may be found on page 9-11 of the audited financial statements. |
| Part III, Line 8: | 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 Centers for Medicare & Medicaid Services. The costs themselves are a community benefit as the community would not receive these services if we did not provide them. |
| Part III, Line 9b: | It is the policy of the Ashley Medical Center to forego extraordinary collection efforts against an individual before the organization has made a reasonable effort to determine whether the individual is eligible for assistance under the hospital charity care policy. Those who qualify for financial assistance will not be charged more than the amount generally billed to other patrons for Emergency Services (described in the EMTALA) or Medically Necessary services. The hospital billings and collections policy provides written notice at least 30 days prior to initiating collection actions. The hospital does not send patient accounts to collections until at least 120 days after the date of the first invoice. If a patient applies for financial assistance within 240 days of the date of the first invoice the hospital will pull that account or invoice back from collections. |
| Part VI, Line 2: | The Ashley Medical Center conducts an annual program review to evaluate current programs as well as determine any future programs that may be needed within our healthcare community. |
| Part VI, Line 3: | Ashley Medical Center provides insurance counseling throughout the year to our patients and provides contact information for state and federal programs. We provide patients of need with a copy of our financial assistance program and post it at various locations throughout the facility including the ER, admissions, and AMC Clinic. Our financial assistance program and its summary is posted to our website. |
| Part VI, Line 4: | Ashley Medical Center (AMC) provides health care services to a rural and frontier geography that includes the cities of Ashley, Lehr, Zeeland and Wishek in McIntosh County. In Logan County we serve the cities of Gackle, Fredonia, and Napoleon. Dickey County cities include Ellendale and Forbes. In Emmons County we have patients from Hague and Strasburg. We also have patients from Kulm located in LaMoure County. All the preceding counties are located in North Dakota. In South Dakota we serve patients from Long Lake and the Leola area located in McPherson County as well as Eureka in Campbell County. In total we serve around 3500 people. There are approximately 3.5 persons per square mile, compared to about 80 per square mile across the United States. AMC strives to provide access to the best quality of care, regardless of the geographic barrier.Socio-Economic Status: Socio-Economic Status: McIntosh County has a high number of Medicare recipients, with 30.7% over 65 in 2018. The median income for a household is $50,739. The per capita income for the county is $32,389, 13.6% of the population is below the poverty level. Because of the low income levels, it is imperative that the patients be able to have access to the highest levels of medical care, without having to travel great distances and incur great costs.Race and Ethnicity: The racial makeup of McIntosh Co is 96.3% White, 0.05% Black or African American, 0.7% Native American, 0.29% Asian, 1.5% Pacific Islander, 0.00% from other races and 0.9% from two or more races. 2.4% of the population is Hispanic or Latino.The Ashley Medical Center serves as a "hub" for community-based health services, integrating different levels of care and services through one organizational structure. We are essential to our patients not only for acute care and emergency care services but also are the link for primary care, nursing home services, elder care services and living structures. AMC extends beyond the standard definition of a hospital.AMC serves an ever growing vulnerable population. This is due to the high number of elderly in our service area. The Medicare factor exacerbates access issues related to geographical considerations, income disparity, lower insurance coverage, and greater health disparities. |
| Part VI, Line 5: | In Fiscal Year 2022 the Ashley Medical Center continued its cooperation with Bismarck State College in bringing the Dakota Nursing Program to the community of Ashley. We currently are hosting an LPN course, with two students pursuing an LPN Degree.Our Heart Check wellness clinic was put on hold due to COVID. Due to numerous requests for us to continue with this vital health screening program, we revised it to enable us to provide the screening individually at any time during the calendar quarter of their birthdates. We offer this screening at a reduced rate of $50, our regular lab charges are $205 for the tests provided. We started this last year and had success with it so we decided to continue offering this revised version. |
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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Lori Bichler | PersonNm |
| Title | Nurse Practitioner | TitleTxt |
| Base Compensation Filing Org | $216,553 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $18,070 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $234,623 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Kathy Jenner | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Family member of board member | RelationshipDescriptionTxt |
| Transaction | $111,584 | TransactionAmt |
| Transaction | Employee Compensation | 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 shall consist of the President, the Vice President, the Secretary and two additional members of the Board of Directors, elected by the Board of Directors at its organization meeting following the annual meeting of the members. The Executive Committee shall have the power to transact all regular business of the corporation during the period between the meetings of the Board of Directors, subject to any prior limitation imposed by the Board of Directors and with the understanding that all matters of major importance will be referred to the Board of Directors. The Executive Committee currently operates with the President, Vice President, Secretary and one additional board member. |
| Form 990, Part VI, Section A, line 6 | Membership or stockholders are given voting rights by making a $100 contribution to the Ashley Medical Center. |
| Form 990, Part VI, Section A, line 7a | All members that have made a $100 donation to the Ashley Medical Center are able to elect our Board of Directors. |
| Form 990, Part VI, Section B, line 11b | All board members received a copy of the 990 in the monthly board packet, which is reviewed at the board meeting prior to being filed with the IRS. |
| Form 990, Part VI, Section B, line 12c | The conflict of interest policy covers the board of directors and officers. The directors and officers are required to annually disclose any potential conflicts. The board of directors reviews for conflicts. If a conflict is identified the person must abstain from voting and remove themselves from discussions. |
| Form 990, Part VI, Section B, line 15 | The compensation for Eric Heupel was approved by the independent board using comparative data. The deliberation process for reasonable compensation was substantiated in the minutes. The CFO salary is annually determined by the board and compared to the state hospital association salary survey. |
| Form 990, Part VI, Section C, line 19 | The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Management is responsible for honoring these requests. |
| Form 990, Part IX, line 11g | Professional Fees: Program service expenses 1,150,689. Management and general expenses 131,730. Fundraising expenses 0. Total expenses 1,282,419. |
Comments