2023-08-10T11:46:26-05:00 2022-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2021-10-01 450227391 Presentation Medical Center PRES 7014773161 213 2nd Avenue NE Rolla ND 583670759 Christopher Albertson President & CEO 7014773161 2023-08-10 1 Christopher Albertson 999009999 Kim Hunwardsen CPA P00484560 6122536500 2023-07-27 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z SMP Health - St Kateri Christopher Albertson 213 2nd Avenue NE Rolla ND 583670759 16070778 0 0928 X www.pmc-rolla.com X 1939 ND Acute care hospital that is a major medical provider for Rolette County 9 8 158 8 0 0 1289645 1626165 13734263 14318759 68486 118454 -7184 -13343 15085210 16050035 0 0 0 0 7616333 7420796 0 0 0 6216290 7593083 13832623 15013879 1252587 1036156 9429114 9186494 2507435 2026559 6921679 7159935 X Presentation Medical Center in union with the Sisters of Mary of the Presentation, is a Catholic healthcare organization. Through the power and example of Jesus Christ and his gospel values, we are committed to joyfully provide wholistic care and healing with integrity, compassion and respect to all we serve. 0 0 12223245 14318759 Presentation Medical Center dba SMP Health - St. Kateri is a 25-bed not-for-profit, Critical Access Hospital (CAH) located in Rolla, Rolette County, ND. As a Critical Access Hospital, our organization is, by definition, a community benefit. St. Kateri is a critical infrastructure to our community and is a major medical provider for Rolette County, providing inpatient, outpatient and surgical services. In addition, PMC is a key provider of emergency care with over 4,800 ER visits for fiscal year ending 2022. Services in the areas of Clinic, Lab, Radiology, Respiratory Therapy, Physical Therapy, Cardiac Rehab, and Outreach Specialty Physician services, are also provided.Continued on Schedule O.SMP Health - St. Kateri had 275 acute patient days, 681 swing-bed days and 2,224 extended swing-bed days.The Medical Center provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the Medical Center does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The estimated costs of the charges foregone, based upon an overall cost-to-charge ratio calculation, for the year ended September 30, 2022 were approximately $95,000. 12223245 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 158 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X Paula J Wilkie 7014773161 213 2nd Avenue NE Rolla ND 583670759 Jane Sivertson Chair 0.50 0.00 X X 0 0 0 Steven McAtee Vice Chair 0.50 0.00 X X 0 0 0 Chris Albertson President/CEO 20.00 20.00 X X 0 296078 59095 Matt Odermann Director 0.50 0.00 X 0 0 0 Shelly Counts Director 0.50 0.00 X 0 0 0 Sr Debra Berry Director 0.50 0.00 X 0 0 0 Seth Bercier Director 0.50 0.00 X 0 0 0 Derrick Dixon Director 0.50 0.00 X 0 0 0 Sr Ann Germaine Picard Director 0.50 0.00 X 0 0 0 Paula Wilkie CFO 40.00 0.00 X 0 154779 38146 Maryn Young FNP-BC Nurse Practitioner 40.00 0.00 X 140770 0 17379 Roxanne Jonas MD Emergency Services 40.00 0.00 X 192916 0 19155 Richard Larson MD Family Medicine 40.00 0.00 X 260377 0 5121 Lavonne Charbonneau PA Family Medicine 40.00 0.00 X 121665 0 26483 Jody Sharp NP Emergency Services 40.00 0.00 X 128404 0 12566 844132 450857 177945 7 0 1 0 Fast Staff PO Box 911452 Denver CO 80291 Travel Nursing 1867279 SMP Health PO Box 10007 Fargo ND 58106 Administrative services 661076 Mike Swanson Construction 6250 24th Ave NE Rugby ND 58368 Construction for Clinic/Hospital 460963 National Medical Resourse 2792 E Broadway Ave Bismarck ND 58501 ED & Nursing Locums Service 443398 Medical Solutions PO Box 850737 Minneapolis MN 55485 ED & Nursing Locums Service 224697 6 1608597 17568 1626165 Patient service revenue 622110 13819812 13819812 Pharmacy 622110 204754 204754 Outside Laundry Revenue 812300 184627 184627 109566 109566 14318759 118454 118454 7400 20743 -13343 -13343 -13343 16050035 14318759 0 105111 X 6117104 5222153 894951 142181 121408 20773 718439 613212 105227 443072 378338 64734 568188 568188 26728 26728 44160 44160 3511644 3263737 247907 24898 24898 414474 272769 141705 316584 315376 1208 56691 29399 27292 42945 42945 68077 54433 13644 503226 402372 100854 105796 105796 Medical Supplies 1075566 1075566 Repairs and maintenance 584293 185053 399240 Food 136804 136804 Dues and subscriptions 107977 45076 62901 5032 1753 3279 15013879 12223245 2790634 0 795292 440412 1255934 1784549 241714 217019 7380 19384 10527123 7491208 2679107 3035915 4034687 2866215 415000 823000 9429114 9186494 869399 881299 488954 1145260 1078082 0 71000 0 2507435 2026559 X 6921679 7159935 6921679 7159935 9429114 9186494 X 1036156 -786881 -11019 X X 0 1 X 1 0 X 106798 106798 180619 5652203 4070609 1762213 4356277 3401522 954755 231226 19077 212149 3035915 SMP Health pooled investment funds 2866215 F 2866215 Estimated third-party payor settlements 823000 823000 X 15263154 -786881 -786881 16050035 0 16050035 15013879 0 15013879 0 15013879 Part X, Line 2: The Medical Center believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Medical Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. 1 1 X 1 X 1 X 1 1 0 1 1 95000 95000 0.00630 2874580 2229928 644652 0.04290 2969580 2229928 739652 0.04920 2892921 2527403 365518 0.02430 2892921 2527403 365518 0.02430 5862501 4757331 1105170 0.07350 1 303062 78493 5659713 5642489 17224 X 1 1 1 1 Presentation Medical Center dba SMP Health - St Kateri 213 2nd Avenue NE Rolla ND 583670759 www.smphealth.org/stkateri/ ND5045 X X X X 1 provider based RHC clinic Presentation Medical Center 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X https://smphealth.org/stkateri X 1 21 1 https://smphealth.org/stkateri 0 1 X 100.000000000000 200.000000000000 X X X X 1 1 X X X X 1 X https://smphealth.org/stkateri X https://smphealth.org/stkateri X https://smphealth.org/stkateri X X X X X 1 X 0 X X X X 1 X 0 0 Presentation Medical Center Part V, Section B, Line 5: Throughout the CHNA process Rolette County Public Health was involved. The qualitative primary research methodology consisted of stakeholder interviews and focus group discussions with key community stakeholders, policymakers, and residents. In total, ten one-on-one virtual phone interviews were conducted. Presentation Medical Center Part V, Section B, Line 6b: Rolette Public Health Presentation Medical Center Part V, Section B, Line 11: A Community Health Needs Assessment was completed in fiscal year 2019. The needs identified are to retain primary care providers, youth and drug abuse, and adult obesity. Fiscal year 2022 updates are as follows:One of two Nurse Practitioners left employment at the Hospital. The other remains employed. The Hospital recruited another Physician Assistant this year.The Nurse Practitioner who completed her mental health certification left employment at the Hospital. A new Physician Assistant will continue the MAT program.Adult obesity will not be specifically addressed due to limited resources however the Medical Center has diabetes education classes four times per year that also address obesity.In 2022, SMP Health System St. Kateri's leadership worked with community leaders, underserved populations receiving services in the community, and others to complete its CHNA and identify 15 community health-related needs. The needs will be addressed over the next 3 years.1. Improve drug and other substance abuse early intervention and prevention services2. Increase access to affordable quality childcare3. Increase access to specialty health care providers in the community (e.g., neurologists, endocrinologists)4. Develop crisis or emergency care programs for mental health5. Increase availability of resources to help seniors stay in their homes (e.g., home health, senior meals, etc..)6. Increase the number of mental health providers for adults7. Increase case management services for people with complex chronic health conditions8. Increase drug and other substance abuse treatment services9. Improve general public transportation10. Increase the number of primary care services (such as a family doctor or other provider of routine care)11. Increase the number of mental health providers for children and youth12. Improve transportation services for people needing to go to doctor's appointments or the hospital13. More intentionally engage the Native American community in health and wellness initiatives14. Improve care coordination between the hospital and other clinics, private doctors, or other health service providers15. Enhance community programs to break out of the cycle of poverty (e.g., early childhood education, primary and secondary education, job training)The Hospital will not address need #9 improve general public transportation. The need above is out of the hospital's purview, and as such would be better addressed by other community partners.The Hospital continued to provide a stipend to a Family Practice Physician. The Physician signed his contract to join our hospital team in September. Presentation Medical Center Part V, Section B, Line 13h: St. Kateri also evaluates a patient's family size, income and demographics to determine eligibility for additional free or discounted care to low-income individuals. Part I, Line 3c: St. Kateri also evaluates a patient's family size and demographics to determine eligibility for additional free or discounted care to low-income individuals. Part I, Line 6a: St. Kateri's community benefit report is available upon request. Part I, Line 7: Charity care expense was converted to cost based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. Part III, Line 2: The amount reported on line 2 represents implicit price concessions. The Hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients. Part III, Line 3: The Hospital reasonably estimates the portion of implicit price considerations that could have qualified for charity care by identifying the uninsured, underinsured, and account balances assigned to a collection agency in the current year. An estimated 25.9% of implicit price concessions in 2021 are attributable to patients living below the federal poverty guidelines in Bottineau County. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 10 and 11 of the attached audited financial statements. Part III, Line 8: Presentation Medical Center provides services to patients under the Medicare program regardless of a shortfall or surplus. The Hospital knows they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Hospital services reimbursed on a fee schedule are not included in the Medicare calculation per the 990 instructions. Had this been reported the total loss from Medicare services would have been $186,011.Medicare fee schedule revenue $ 109,260Medicare estimated costs of care relating to payments (295,271)Net (Shortage) $ (186,011)Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicaid and Medicare Services. Part III, Line 9b: Presentation Medical Center believes it has an obligation to make every effort possible to collect for services rendered from all patients who have the ability to pay their account. There are no collection efforts for patients who qualify for charity care or financial assistance, indigent patients, or patients that have set up payment arrangements. If a portion of an account is written off to charity care, any personal portion due follows the same collection procedures as other accounts. For patients who are indigent, Presentation Medical Center has a Charity Care provision with the appropriate application process. For self-pay patients, Presentation Medical Center offers a prompt payment discount of 10% for payment in full within 30 days from the date of their first statement. Patients receive 3 statements at 30, 60, and 90 days and are informed that their account will be sent to a collection agency at 120 days. If the patient completes a Charity Care Application anytime up to 240 days of the first post-discharge billing statement, the Hospital will remove the accounts from collections and acknowledge it as Charity Care on the financial statements. Part VI, Line 2: SMP Health - St. Kateri strives to provide basic healthcare services to its communities. We have worked with the Rolette County Public Health, Rolette County Police Department, Rolla Community Ambulance, Rolette County Social Services and other community departments to provide basic care to the members of our community. Working with these organizations allows us to provide different services to our community and to make sure that one of these entities is able to provide care and or cover for one another.Our community health needs assessment is completed and posted to our website to meet the requirements of 501(r). Part VI, Line 3: SMP Health - St. Kateri is committed to providing care to persons who are uninsured, underinsured, ineligible for government programs, or otherwise unable to pay for medically necessary care. Our Community Caring Program was established in 2005. We have seen a continual increase every year in charity care as we try to get patients involved in the program before their accounts are sent to collections. A brochure is provided to every patient when they register outlining our payment expectations and explaining our Community Caring Program. Notification about charity care is available in emergency rooms, admitting and registration departments, the Business office, and other public areas within the Hospital. Information is also included in patient bills and patient information packets. At registration, patients are given the Payment Policy and Community Caring Program handout. This handout explains patient responsibilities, insurance billing guidelines, financing and payment options, and the Community Caring guidelines. Part VI, Line 4: SMP Health - St. Kateri is a 25-bed not-for-profit, Critical Access Hospital (CAH) located in Rolla, Rolette County, ND. As a Critical Access Hospital, our organization is, by definition, a community benefit. SMP Health - St. Kateri is a critical infrastructure to our community and is a major medical provider for Rolette County, providing inpatient, outpatient and surgical services. In addition, the Hospital is a key provider of emergency care and services in the areas of Clinic, Lab, Radiology, Respiratory Therapy, Physical Therapy, Cardiac Rehab, and Outreach Specialty Physician services.SMP Health - St. Kateri is highly dependent upon government Payors. In the Fiscal Year ending 09/30/2022, Medicare was the payor for 39% of patients, while Medicaid was the payor for 38% of patients. By virtue of where we are located and the services that we provide, we are a benefit to our community.The service area includes Rolette and part of Towner County. Rolette County has a total population of 14,179 with 78% the population being Native American. With this census, 1.86% of North Dakota's population lives in Rolette County. The per capita income for Rolette County is $19,295 compared with North Dakota's per capita income of $39,884 with 25.9% of the county living below the poverty guidelines. (Source: U.S. Census Bureau). Part VI, Line 5: SMP Health - St. Kateri works to address the basic healthcare needs in Rolette County and the surrounding communities. The Hospital is a major medical provider for the county providing inpatient, outpatient, and surgical services. In addition, SMP Health - St. Kateri is a key provider of emergency care. The emergency room is open 24 hours and is available regardless of a person's ability to pay.The Hospital extends medical staff privileges to all qualified physicians who meet the Medical Staff Bylaws. Surplus funds are used for equipment upgrades and facility improvements. A majority of the organization's governing body resides in Rolla, ND and none are contractors of the organization. The governing body does not have any family relationships with each other.In addition to our very existence, SMP Health - St. Kateri believes that there are additional areas that highlight our benefit to the community. By being what and who we are, we strive to be a good community citizen and an asset to the communities that we serve. The Hospital routinely provides a variety of services that address needs within the community. Part VI, Line 6: We are an affiliate of the Sisters of Mary of the Presentation Health System dba SMP Health. SMP Health - St. Kateri operates in accordance with the mission, vision, and values of the SMP Health. Our annual budgeting process includes an assessment of how our budget demonstrates a commitment to the values of the system and the system works to ensure we are always mindful of our duty to care for the poor and those in need. SMP Health - St. Kateri has a Strategic Plan developed from themes set forth by the health system for all affiliates. 0 1 0 0 0 0 0 0 0 Chris Albertson President/CEO 0 262500 0 21971 0 11607 0 28633 0 33345 0 358056 0 5607 Richard Larson MD Family Medicine 260377 0 0 0 0 0 5121 0 0 0 265498 0 0 0 Roxanne Jonas MD Emergency Services 192916 0 0 0 0 0 3008 0 16146 0 212070 0 0 0 Paula Wilkie CFO 0 139090 0 9736 0 5953 0 6968 0 32860 0 194607 0 0 Maryn Young FNP-BC Nurse Practitioner 140770 0 0 0 0 0 4079 0 13300 0 158149 0 0 0 Part I, Line 3 Presentation Medical Center does not pay compensation to the President & CEO. This individual is compensated by Sisters of Mary of the Presentation Health System, a related organization, for services to the Medical Center. Sisters of Mary of the Presentation Health System uses one or more of the methods in Part I, question 3 to determine compensation. Part I, Line 4b SMP Health, related organization, has a nonqualified deferred compensation plan that complies with Section 409A of the IRC. SMP Health begins contributions into the plan after the employee's first year of service. The employee is vested based on a 20 year vesting schedule or becomes fully vested in the event of death, disability or reaching the age of 65. Employee name and amounts included on Schedule J are as follows: Name Part II, column B (iii) Part II, column C Chris Albertson $5,607 $8,917 Paula Wilkie 5,953 Form 990, Part VI, Section A, line 6 The sole member of the organization is the Sisters of Mary of the Presentation Health System dba SMP Health . Form 990, Part VI, Section A, line 7a The member is entitled to vote in the election of Directors and to cast one vote for each Director to be elected. The member is also entitled to one vote on every other matter to be voted on by the member. Votes cast on behalf of the member are cast by the Chief Executive Officer of Sisters of Mary of the Presentation Health System dba SMP Health. Form 990, Part VI, Section A, line 7b The authority to act on the following matters are exclusively vested in the member of the organization: 1. any change in the philosophy, objectives and purposes of the organization; 2. amendment of the articles of incorporation and bylaws; 3. the election or removal of the Directors; 4. merger or consolidation with any other organization; 5. dissolution of the organization or the sale, lease or exchange of all or substantially all of its property or assets; 6. the sale, lease, transfer or encumbrance of any land, buildings or other assets owned by the organization or in which the organization has or will have equitable or legal title; 7. approval of the annual operating and capital budgets; 8. appointment of the Chief Executive Officer. Form 990, Part VI, Section A, line 8b The Organization does not have committees with authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The Form 990 is distributed to the governing body before it is filed. The CEO and CFO review the Form 990. Form 990, Part VI, Section B, line 12c Each Director must submit in writing to the Chairperson of the Board and the CEO a list of all business or other organizations of which the individual is an officer, director, trustee, member, owner (either as a sole proprietor or partner), shareholder with a 5% or greater interest in all outstanding voting shares, employee or agent, with which the organization has, or might reasonably in the future enter into, a relationship or a transaction in which the Director would have conflicting interests. Each written statement is resubmitted with any necessary changes each year. The Chairperson of the Board reviews the statements of the Directors and the Vice Chairperson of the Board reviews the statement filed by the Chairperson. When a conflict arises the affected Director makes known the potential conflict, whether disclosed by written statement or not, and after answering any questions, will withdraw from the meeting for as long as the matter continues under discussion. Should the matter be brought to a vote, the affected Director will not vote on it. In the event the Director does not withdraw voluntarily, the Chairperson of the Board has authority to require the Director to remove himself from the room during both the discussion and vote on the matter. In the event the conflict of interest affects the Chairperson, the Vice Chairperson has authority to require the Chairperson remove himself in the same matter. If the matter is the item of business for which a special meeting of the Board was called, the affected Director will not be counted to establish a quorum, and he will not participate in the deliberations or vote on it. Form 990, Part VI, Section B, line 15 The Organization's CEO and CFO are both compensated by Sisters of Mary of the Presentation Health System, a related organization. The compensation process is determined by the related organization. The Sisters of Mary of the Presentation Health System Board of Trustees directly engages a nationally recognized independent compensation consulting firm to review the total compensation arrangements of the officers and key employees. The Sisters of Mary of the Presentation Health System Board of Trustees approves all compensation based on comparable data and documents their decision in the meeting minutes. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are available to the public upon written request. Form 990, Part IX, line 11g Purchased services: Program service expenses 3,263,737. Management and general expenses 142,754. Fundraising expenses 0. Total expenses 3,406,491. Professional fees: Program service expenses 0. Management and general expenses 105,153. Fundraising expenses 0. Total expenses 105,153. Form 990, Part XI, line 9: Equity Transfer to Related Party -11,019. Form 990, Part XII, Line 2c: The governing board of Sisters of Mary of the Presentation Health System dba SMP Health assumes responsibility for oversight of the audit for SMP Health - St. Kateri. Hygienic Institute For LaSalle Peru and Oglesby 925 W St Peru IL 61354 362167742 Provide primary health care servcies IL 501(c)(3) Line 10 IV HealthCorp Inc 0 Illinois Valley Community Hospital Foundation 925 W St Peru IL 61354 371211780 Support IV HealthCorp, Inc. IL 501(c)(3) Line 12a, I IV HealthCorp Inc 0 IV HealthCorp Inc 925 W St Peru IL 61354 371211890 Support SMP affiliated entities IL 501(c)(3) Line 12a, I St Margaret's Health 0 Sisters of Mary of the Presentation Health Ministry 1202 Page Drive SW Fargo ND 58106 320617468 Supports SMP Health and the related entities ND 501(c)(3) Canonical Entity N/A 0 Sisters of Mary of the Presentation Health System 1202 Page Drive SW Fargo ND 58103 450359620 Support related ND Catholic Health Care System ND 501(c)(3) Line 12a, I SMP Health Ministry 0 Sisters of Mary of the Presentation Long Term Care 1202 Page Drive SW Fargo ND 58103 752999939 Provide extended care and medically related services ND 501(c)(3) Line 10 SMP Health System 0 Sisters of Mary of the Presentation Prairieland Home Care dba Prairieland 1102 Page Drive SW Fargo ND 58106 450391192 Home health and supportive services ND 501(c)(3) Line 10 SMP Health 0 SMP Illinois Region Health System dba St Margaret's Health 600 E 1st St Spring Valley IL 61362 842023121 Support related Illinois health care entities IL 501(c)(3) Line 12a, I SMP Health 0 St Aloisius Medical Center dba SMP Health - St Aloisius 325 East Brewster Street Harvey ND 58341 450226729 Provision of health care services ND 501(c)(3) Line 3 SMP Health System 0 St Andrew's Health Center dba SMP Health - St Andrew's 316 Ohmer Street Bottineau ND 58318 450226426 Provision of health care services ND 501(c)(3) Line 3 SMP Health System 0 St Andrew's Hospital Foundation dba SMP Health St Andrew's Foundation Inc 316 Ohmer St Bottineau ND 58318 450413201 Support SMP Health - St. Andrew's ND 501(c)(3) Line 12a, I SMP Health Ministry 0 St Margaret's Health - Spring Valley 600 E 1st St Spring Valley IL 61362 362167884 Provision of health care services IL 501(c)(3) Line 3 St Margaret's Health 0 St Margaret's Health-Peru 925 W St Peru IL 61354 362852553 Provision of health care services IL 501(c)(3) Line 3 IV HealthCorp Inc 0 St Margaret's Hospital Foundation 600 East First Street Spring Valley IL 61362 364042262 Provide support to St. Margaret's Hospital IL 501(c)(3) Line 12a, I SMP Health System 0 Valley Regional Health Services L3C 4391 Venture Drive Peru IL 613541014 273891281 Outpatient oncology services IL N/A 0 1 SMP Enterprises PO Box 10007 Fargo ND 581060007 363486506 Collection agency ND N/A C 0 SMP Enterprises - IL 600 East 1st Street Spring Valley ND 61362 363456566 Healthcare management IL N/A C 0 Valley Health Enterprises Inc 925 W St Peru IL 61354 363476877 Home medical equipment IL N/A C 0 Illinois Valley Health Services Inc 925 W St Peru IL 61354 364050682 Inative IL N/A C 0 Health Care Building Corp 925 W St Peru IL 61354 363306917 Inactive IL N/A C 0 IVCH General Professional Liability Loss Fund 925 West Street Peru IL 61354 366673231 Inactive IL N/A T 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 0