CHISHOLM HEALTH CENTER: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- CHISHOLM HEALTH CENTER (EIN 41-1879639)
- Tax period
- 2020-10-01 to 2021-09-30
- Filed
- 2022-02-15
- IRS object ID
- 202210469349301341
- Schema version
- 2020v4.0
- 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 D
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-02-15T12:45:24-06:00 | ReturnTs |
| Tax Period End | 2021-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 411539592 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CONWAY DEUTH & SCHMIESING PLLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 ATLANTIC AVE | AddressLine1Txt |
| City | MORRIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 562671324 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411879639 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHISHOLM HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHIS | BusinessNameControlTxt |
| Phone | 2182545765 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 NE 6TH STREET | AddressLine1Txt |
| City | CHISHOLM | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55719 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARI CHAMBERS | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 2182545765 | PhoneNum |
| Signature | 2022-02-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MARI | PersonFirstNm |
| Person Last | CHAMBERS | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 666666666 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KELLY M DEMUTH | PreparerPersonNm |
| PTIN | P00947751 | PTIN |
| Phone | 3205892602 | PhoneNum |
| Preparation | 2022-02-12 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CAROL RAW | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 NEVADA AVENUE | AddressLine1Txt |
| City | MORRIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56267 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $7,842,728 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SFHS.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1997 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | WE ARE COMMITTED TO EXPRESSING CHRIST'S MESSAGE OF LOVE BY PROVIDING CARE THAT VALUES EVERY HUMAN LIFE. ST FRANCIS HEALTH SERVICES CONTROLS AND OPERATES CHISHOLM HEALTH CENTER AND IS SPONSORED BY THE CATHOLIC DIOCESE OF ST CLOUD. WE AGREE TO PROMOTE THE ETHICAL AND RELIGIOUS DIRECTIVE FOR CATHOLIC HEALTH CARE SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 170 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $140,642 | PYContributionsGrantsAmt |
| CY Contributions Grants | $892,178 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $7,616,327 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $6,946,201 | CYProgramServiceRevenueAmt |
| PY Investment Income | $3,087 | PYInvestmentIncomeAmt |
| CY Investment Income | $432 | CYInvestmentIncomeAmt |
| PY Other Revenue | $46,798 | PYOtherRevenueAmt |
| CY Other Revenue | $553 | CYOtherRevenueAmt |
| PY Total Revenue | $7,806,854 | PYTotalRevenueAmt |
| CY Total Revenue | $7,839,364 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $8,192 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $8,659 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,648,293 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,693,340 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,744,425 | PYOtherExpensesAmt |
| CY Other Expenses | $2,615,429 | CYOtherExpensesAmt |
| PY Total Expenses | $7,400,910 | PYTotalExpensesAmt |
| CY Total Expenses | $7,317,428 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $405,944 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $521,936 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,924,242 | TotalAssetsBOYAmt |
| Total Assets EOY | $10,701,216 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,594,162 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,767,508 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,330,080 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,933,708 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WE ARE COMMITTED TO EXPRESSING CHRIST'S MESSAGE OF LOVE BY PROVIDING CARE THAT VALUES EVERY HUMAN LIFE. ST FRANCIS HEALTH SERVICES CONTROLS AND OPERATES CHISHOLM HEALTH CENTER AND IS SPONSORED BY THE CATHOLIC DIOCESE OF ST CLOUD. WE AGREE TO PROMOTE THE ETHICAL AND RELIGIOUS DIRECTIVE FOR CATHOLIC HEALTH CARE SERVICES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $6,388,495 | ExpenseAmt |
| Grant | $8,659 | GrantAmt |
| Revenue | $6,946,201 | RevenueAmt |
| Desc | CHISHOLM HEALTH CENTER IS A 70 BED SKILLED NURSING FACILITY LOCATED IN RURAL MINNESOTA. THE FACILITY PROVIDES MEDICAL, SOCIAL, AND SPIRITUAL CARE TO ITS RESIDENTS WITHOUT REGARD TO RACE, COLOR, CREED, OR NATIONAL ORIGIN, IN FURTHERANCE OF THE ORGANIZATION'S EXEMPT STATUS. DURING THE CURRENT REPORTING YEAR, THE ORGANIZATION HAD 18,236 PATIENT DAYS AND PROVIDED SERVICES TO MORE THAN 129 PATIENTS. ALSO DURING THIS TIME PERIOD, THE ORGANIZATION EMPLOYED ABOUT 73 FULL TIME EQUIVALENT EMPLOYEES AND GROSS WAGES PAID OUT WERE MORE THAN 3,500,000. THIS WAS ALL PROVIDED IN AN AREA WHERE MEDICAL AND EMPLOYMENT OPPORTUNITIES ARE VERY LIMITED. | Desc |
| Total Program Service Expenses | $6,388,495 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | Yes (true) | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (true) | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 7 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 170 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARI CHAMBERS | PersonNm |
| Phone | 2182545765 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 NEVADA AVE | AddressLine1Txt |
| City | MORRIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56267 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|---|
| CAROL RAW | |||||||||
| PRES/CEO | 1.00 | 39.00 | Yes (X) | $0 | $228,446 | $27,602 | |||
| PAULA HENDRICKSON | |||||||||
| ADMIN - MHS | 0.00 | 40.00 | $0 | $191,613 | $36,921 | Yes (X) | |||
| TAMARA RETZLAFF | |||||||||
| NURSING CHAR | 0.00 | 40.00 | $0 | $188,410 | $36,927 | Yes (X) | |||
| JODY CUNNINGHAM | |||||||||
| DIR OF NURSI | 0.00 | 40.00 | $0 | $159,810 | $39,339 | Yes (X) | |||
| SCOT ALLEN | |||||||||
| VP - SEN SRV | 1.00 | 14.00 | Yes (X) | $0 | $167,031 | $23,936 | |||
| JILL MONTZKA | |||||||||
| NURSING LPN | 0.00 | 40.00 | $0 | $146,958 | $28,530 | Yes (X) | |||
| GEOFFREY RYAN | |||||||||
| SEN SVC REG | 1.00 | 39.00 | $0 | $155,750 | $19,463 | Yes (X) | |||
| WILLIAM MONCRIEF | |||||||||
| FORMER - CFO | 1.00 | 39.00 | $0 | $124,256 | $17,903 | Yes (X) | |||
| LEAH NELSON | |||||||||
| FORMER - VP | 1.00 | 39.00 | $0 | $121,389 | $17,829 | Yes (X) | |||
| SHERY WAGNER | |||||||||
| CONTROLLER | 1.00 | 36.00 | Yes (X) | $0 | $100,703 | $5,191 | |||
| KEITH DAVIDSON | |||||||||
| DIRECTOR | 1.00 | 14.00 | $0 | $0 | $0 | Yes (X) | |||
| DANIEL DRIPPS | |||||||||
| DIRECTOR | 1.00 | 14.00 | $0 | $0 | $0 | Yes (X) | |||
| JENNIFER ANN GOODNOUGH | |||||||||
| DIRECTOR | 1.00 | 14.00 | $0 | $0 | $0 | Yes (X) | |||
| PAUL LETENDRE | |||||||||
| DIRECTOR | 1.00 | 14.00 | $0 | $0 | $0 | Yes (X) | |||
| ELIZABETH MEICHSNER | |||||||||
| VICE CHAIR | 1.00 | 14.00 | $0 | $0 | $0 | Yes (X) | |||
| PATRICK NELSON | |||||||||
| DIRECTOR | 1.00 | 14.00 | $0 | $0 | $0 | Yes (X) | |||
| JOAN REICOSKY | |||||||||
| DIRECTOR | 1.00 | 14.00 | $0 | $0 | $0 | Yes (X) | |||
| REV TODD P SCHNEIDER | |||||||||
| DIRECTOR | 1.00 | 14.00 | $0 | $0 | $0 | Yes (X) | |||
| JENNIFER JEANNE SEALES | |||||||||
| DIRECTOR | 1.00 | 14.00 | $0 | $0 | $0 | Yes (X) | |||
| TAMELA SPERR | |||||||||
| DIRECTOR | 1.00 | 14.00 | $0 | $0 | $0 | Yes (X) | |||
| ALYSSA THOOFT | |||||||||
| CHAIR | 1.00 | 14.00 | $0 | $0 | $0 | Yes (X) | |||
| KENNETH WESTBROCK | |||||||||
| DIRECTOR | 1.00 | 14.00 | $0 | $0 | $0 | Yes (X) | |||
| LORRAINE WIESE | |||||||||
| SECR. / TRES | 1.00 | 14.00 | $0 | $0 | $0 | Yes (X) | |||
| MARI CHAMBERS | |||||||||
| CFO | 1.00 | 39.00 | Yes (X) | $0 | $0 | $0 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Reportable Comp Rltd Org | $1,584,366 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $253,641 | TotalOtherCompensationAmt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| BIG STONE THERAPIES INC | |||||
| 309 WASHINGTON AVE | ORTONVILLE | MN | 56278 | PROVIDE THERAPY | $617,249 |
| ST FRANCIS HEALTH SERVICES | |||||
| 801 NEVADA AVE | MORRIS | MN | 56267 | MANAGEMENT FEES | $276,283 |
| PRAIRIE DESIGN STUDIO | |||||
| 601 SHEYENNE ST | HORACE | ND | 58047 | ARCHITECT | $255,546 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $890,742 | GovernmentGrantsAmt |
| All Other Contributions | $1,436 | AllOtherContributionsAmt |
| Total Contributions | $892,178 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| NET RESIDENT SERVICE REVENUE | $6,945,692 | $6,945,692 |
| MEALS INCOME | $509 | $509 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $6,946,201 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,796 | TotalRevenueColumnAmt |
| Exclusion | $3,796 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $3,364 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$3,364 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$3,364 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$3,364 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| MISCELLANEOUS | $548 | $548 |
| ROUNDING | $5 | $5 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $553 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,839,364 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,943,390 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $3,796 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,659 | TotalAmt |
| Program Services | $8,659 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,576,806 | TotalAmt |
| Program Services | $3,313,794 | ProgramServicesAmt |
| Management And General | $263,012 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $123,007 | TotalAmt |
| Program Services | $113,962 | ProgramServicesAmt |
| Management And General | $9,045 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $672,218 | TotalAmt |
| Program Services | $622,788 | ProgramServicesAmt |
| Management And General | $49,430 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $321,309 | TotalAmt |
| Program Services | $297,682 | ProgramServicesAmt |
| Management And General | $23,627 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $234,000 | TotalAmt |
| Management And General | $234,000 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,866 | TotalAmt |
| Management And General | $7,866 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,293 | TotalAmt |
| Management And General | $8,293 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,606 | TotalAmt |
| Management And General | $3,606 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,317 | TotalAmt |
| Management And General | $24,317 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $168,249 | TotalAmt |
| Program Services | $168,249 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,785 | TotalAmt |
| Management And General | $2,785 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,339 | TotalAmt |
| Program Services | $6,358 | ProgramServicesAmt |
| Management And General | $3,981 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,289 | TotalAmt |
| Program Services | $80,289 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $318,973 | TotalAmt |
| Program Services | $318,973 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,010 | TotalAmt |
| Program Services | $26,840 | ProgramServicesAmt |
| Management And General | $10,170 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL PROF. FEES | $623,083 | $623,083 | |
| SUPPLIES | $303,624 | $303,624 | |
| MEDICAL SURCHARGE | $197,050 | $197,050 | |
| GENERAL & ADMIN EXPENSE | $163,725 | $163,725 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $432,220 | TotalAmt |
| Program Services | $307,144 | ProgramServicesAmt |
| Management And General | $125,076 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,317,428 | TotalAmt |
| Program Services | $6,388,495 | ProgramServicesAmt |
| Management And General | $928,933 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,466,955 | BOYAmt |
| EOY | $2,085,508 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $909,528 | BOYAmt |
| EOY | $809,458 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,790 | BOYAmt |
| EOY | $26,108 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $13,020,338 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,240,196 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,539,969 | BOYAmt |
| EOY | $7,780,142 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,924,242 | BOYAmt |
| EOY | $10,701,216 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $581,469 | BOYAmt |
| EOY | $1,998,344 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $337,123 | BOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,222,495 | BOYAmt |
| EOY | $2,045,590 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,090 | BOYAmt |
| EOY | $5,875 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $506,788 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$62,803 | BOYAmt |
| EOY | $3,717,699 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,594,162 | BOYAmt |
| EOY | $7,767,508 | 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 | $2,330,080 | BOYAmt |
| EOY | $2,933,708 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,330,080 | BOYAmt |
| EOY | $2,933,708 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,924,242 | BOYAmt |
| EOY | $10,701,216 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $521,936 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $81,692 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,592 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,629 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,442 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $140,642 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $892,178 | CurrentTaxYearAmt |
| Total | $1,041,483 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,658,844 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,793,713 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,870,079 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $7,663,125 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,946,754 | CurrentTaxYearAmt |
| Total | $34,932,515 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,661,436 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,797,342 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,872,521 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $7,803,767 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $7,838,932 | CurrentTaxYearAmt |
| Total | $35,973,998 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $820,855 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $763,210 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,048,003 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,742,916 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,226,144 | CurrentTaxYearAmt |
| Total | $5,601,128 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $820,855 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $763,210 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,048,003 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,742,916 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,226,144 | CurrentTaxYearAmt |
| Total | $5,601,128 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $30,372,870 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,452 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,242 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,561 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,087 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,796 | CurrentTaxYearAmt |
| Total | $11,138 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,452 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,242 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,561 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,087 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,796 | CurrentTaxYearAmt |
| Total | $11,138 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,662,888 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,798,584 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,874,082 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $7,806,854 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $7,842,728 | CurrentTaxYearAmt |
| Total | $35,985,136 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.84400 | PublicSupportCY509Pct |
| Public Support PY509 | 0.83340 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00000 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (true) | AgentTrusteeEtcInd |
| Beginning Balance | $9,090 | BeginningBalanceAmt |
| Additions During Year | $15,289 | AdditionsDuringYearAmt |
| Distributions During Year | $18,504 | DistributionsDuringYearAmt |
| Ending Balance | $5,875 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | Yes (true) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,000 | OtherCostOrOtherBasisAmt |
| Book Value | $10,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,130,864 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,039,089 | DepreciationAmt |
| Book Value | $3,091,775 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,200 | OtherCostOrOtherBasisAmt |
| Depreciation | $360 | DepreciationAmt |
| Book Value | $840 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $251,078 | OtherCostOrOtherBasisAmt |
| Depreciation | $200,747 | DepreciationAmt |
| Book Value | $50,331 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,627,196 | OtherCostOrOtherBasisAmt |
| Book Value | $4,627,196 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,780,142 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO RELATED PARTIES | $3,754,137 |
| LEASE OBLIGATIONS PAYABLE | $18,559 |
| DEFERRED FINANCING - TE BONDS | -$54,997 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,717,699 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 2, PART IV, LINE 1B | THE ORGANIZATION ACTS AS A CUSTODIAN FOR THE FUNDS OF THE RESIDENTS. |
| SCHEDULE D, PAGE 2, PART IV, LINE 2B | THE ORGANIZATION ACTS AS A CUSTODIAN FOR THE FUNDS OF THE RESIDENTS. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIP | GrantTypeTxt |
| Recipient | 6 | RecipientCnt |
| Cash Grant | $8,659 | CashGrantAmt |
| Valuation Method Used | FMV | ValuationMethodUsedDesc |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt |
|---|---|---|---|---|
| CAROL RAW | ||||
| PRES/CEO | $228,446 | $11,920 | $15,682 | $256,048 |
| PAULA HENDRICKSON | ||||
| ADMIN - MHS | $191,613 | $10,116 | $26,805 | $228,534 |
| TAMARA RETZLAFF | ||||
| NURSING CHARGE RN | $188,410 | $10,125 | $26,802 | $225,337 |
| JODY CUNNINGHAM | ||||
| DIR OF NURSING | $159,810 | $8,916 | $30,423 | $199,149 |
| SCOT ALLEN | ||||
| VP - SEN SRVCS | $167,031 | $8,588 | $15,348 | $190,967 |
| JILL MONTZKA | ||||
| NURSING LPN | $146,958 | $7,406 | $21,124 | $175,488 |
| GEOFFREY RYAN | ||||
| SEN SVC REG DIRECT | $155,750 | $7,788 | $11,675 | $175,213 |
| WILLIAM MONCRIEF | ||||
| FORMER - CFO | $124,256 | $6,228 | $11,675 | $142,159 |
| LEAH NELSON | ||||
| FORMER - VP OF HR | $121,389 | $6,154 | $11,675 | $139,218 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Business Name Line2IssuerName/BusinessNameLine2Txt | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| BREMER BANK | ||||||||
| A | HCF REV NOTE 2009A | 416005047 | 2009-10-21 | $1,143,804 | REFINANCING TAXABLE INDEBTEDNESS INCURRED TO FINANCE GENERAL REMODELING, INFRASTRUCTURE IMPROVEMENTS | false | false | false |
| BREMER BANK | ||||||||
| B | REVENUE NOTE 2016 | 416005047 | 2015-12-10 | $1,914,128 | REFINANCING DEBT | false | false | false |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|
| A | $64,610 | false | false | Yes (true) | Yes (true) |
| B | $82,597 | false | false | false | false |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | false | false | false | false | false | false | Yes (true) |
| B | false | false | false | false | false | false | false |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|
| A | Yes (true) | Yes (true) | false | false | false | Yes (true) |
| B | Yes (true) | false | false | false | false | false |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (true) |
| B | Yes (true) |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PURPOSE OF ISSUE DESCRIPTION | BREMER BANK REFINANCING TAXABLE INDEBTEDNESS INCURRED TO FINANCE GENERAL REMODELING, INFRASTRUCTURE IMPROVEMENTS AND WINDOW REPLACEMENT. |
| PURPOSE OF ISSUE DESCRIPTION | BREMER BANK REFINANCING DEBT |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (6 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| ELIZABETH LETICH - DAUGHTER OF | |||
| CAROL RAW, CEO | $105,003 | EMPL -ADMIN FHS | false |
| ANDY RAW - SON OF | |||
| CAROL RAW, CEO | $45,131 | EMPL -MAINT BVHS | false |
| KAITLYN PENISKA - RELATIVE LAURIE | |||
| PENISKA, DON | $34,258 | EMPL -NUR ASST BVHS | false |
| DENNIS LINDOR - HUSBAND OF DAWN | |||
| BJORGE, DON/TR | $36,411 | EMPL -CORP STAFF PCS | false |
| JUSTIN NELSON - SON OF LEAH | |||
| NELSON - VP HR | $44,629 | EMPL -IT ANALY SFHS | false |
| CHANTEL TRIGGS - WIFE OF JOHNATHON | |||
| TRIGGS, DON | $12,504 | EMPL -RN ZHS | false |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART V | FormAndLineReferenceDesc |
| Explanation | DURING THE YEAR, THE ORGANIZATION EMPLOYS INDIVIDUALS WHO MAY BE RELATED TO AN OFFICER, DIRECTOR, TRUSTEE, OR KEY EMPLOYEE. PAYMENTS FOR SERVICES ARE MADE ACCORDING TO EMPLOYMENT POLICY AND DONE AT ARMS LENGTH. DUE TO THE RURAL LOCATION OF THE ORGANIZATION AND THE NEED TO FIND QUALIFIED STAFF, THESE EMPLOYMENT RELATIONSHIPS ARE NECESSARY TO FURTHER THE ORGANIZATION'S EXEMPT PURPOSE. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | WE ARE COMMITTED TO EXPRESSING CHRIST'S MESSAGE OF LOVE BY PROVIDING CARE THAT VALUES EVERY HUMAN LIFE. ST FRANCIS HEALTH SERVICES CONTROLS AND OPERATES CHISHOLM HEALTH CENTER AND IS SPONSORED BY THE CATHOLIC DIOCESE OF ST CLOUD. WE AGREE TO PROMOTE THE ETHICAL AND RELIGIOUS DIRECTIVE FOR CATHOLIC HEALTH CARE SERVICES. |
| FORM 990, PAGE 6, PART VI, LINE 3 | ST. FRANCIS HEALTH SERVICES OF MORRIS, INC (A RELATED ORGANIZATION WITH COMMON CONTROL) MANAGES THE FACILITY. |
| FORM 990, PAGE 6, PART VI, LINE 6 | THE ORGANIZATION IS ORGANIZED WITH MEMBERS. THE MEMBERS OF THE CORPORATION SHALL CONSIST OF THE BOARD OF DIRECTORS OF ST. FRANCIS HEALTH SERVICES OF MORRIS, INC. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE CFO OF ST. FRANCIS HEALTH SERVICES OF MORRIS, INC REVIEWS THE TAX RETURN AS PART OF THE MANAGEMENT SERVICES. |
| FORM 990, PAGE 6, PART VI, LINE 12C | ANNUALLY THE ORGANIZATION CONDUCTS IN-SERVICE TRAINING REVIEWING THE POLICY ON CONFLICTS OF INTEREST AND REQUIRES THE BOARD MEMBERS, MANAGEMENT STAFF, AND KEY EMPLOYEES TO DISCLOSE CONFLICTS. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE CEO AND OFFICERS ARE EMPLOYEES OF ST. FRANCIS HEALTH SERVICES OF MORRIS, INC (A RELATED ORGANIZATION AND UNDER COMMON CONTROL). THE COMPENSATION PROCESS FOR THE CEO - ANNUALLY THE HR DIRECTOR SUBMITS THE CEO'S JOB DESCRIPTION, PERFORMANCE EVALUATION FORM, ST. FRANCIS HEALTH SERVICES OF MORRIS, INC'S PAY GRADE SCHEDULE AND COMPARABLE WAGE SURVEY(S) TO THE CHAIRMAN OF THE BOARD. THE CHAIRMAN AND THE EVALUATION COMMITTEE OF THE BOARD REVIEWS THE PERFORMANCE AND DETERMINES THE SALARY OF THE CEO. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE CEO AND OFFICERS ARE EMPLOYEES OF ST. FRANCIS HEALTH SERVICES OF MORRIS, INC (A RELATED ORGANIZATION AND UNDER COMMON CONTROL). THE COMPENSATION PROCESS FOR OFFICERS - CEO AND THE HR DIRECTOR REVIEWS COMPARABLE WAGE SURVEY INFORMATION, REVIEWS PERFORMANCE (WITH INPUT FROM THE VP, IF APPROPRIATE) AND DETERMINES SALARY. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICIES, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC ON AN AS REQUESTED BASIS. |
| FORM 990, PART XI, LINE 9 | INTERCOMPANY TRANSFER 81,692 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (14 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| AITKIN HEALTH SERVICES | |||||||||||
| 301 MINNESOTA AVENUE | AITKIN | MN | 56431 | 203367397 | CAREGIVER | MN | 501C3 | 10 | SFHS | false | |
| BROWNS VALLEY HEALTH CENTER | |||||||||||
| RR 1 BOX 182D SOUTH JEFFERSON | BROWNS VALLEY | MN | 56219 | 411668347 | CAREGIVER | MN | 501C3 | 10 | SFHS | false | |
| DULUTH HEALTH SERVICES | |||||||||||
| 3111 CHURCH PLACE | DULUTH | MN | 55811 | 411843283 | CAREGIVER | MN | 501C3 | 10 | SFHS | false | |
| FARMINGTON HEALTH SERVICES | |||||||||||
| 3410 23RD STREET W | FARMINGTON | MN | 55024 | 200100365 | CAREGIVER | MN | 501C3 | 10 | SFHS | false | |
| FRANCISCAN HEALTH CENTER | |||||||||||
| 3910 MINNESOTA AVENUE | DULUTH | MN | 55802 | 411799268 | CAREGIVER | MN | 501C3 | 10 | SFHS | false | |
| GUARDIAN ANGELS HEALTH & REHAB CENT | |||||||||||
| 1500 3RD AVENUE E | HIBBING | MN | 55746 | 411810369 | CAREGIVER | MN | 501C3 | 10 | SFHS | false | |
| KOOCHICHING HEALTH SERVICES | |||||||||||
| 901 MAIN STREET | LITTLEFORK | MN | 56663 | 810910949 | CAREGIVER | MN | 501C3 | 10 | SFHS | false | |
| LITTLE FALLS HEALTH SERVICES | |||||||||||
| 1200 NE 1ST AVE | LITTLE FALLS | MN | 56345 | 463626109 | CAREGIVER | MN | 501C3 | 10 | SFHS | false | |
| MORRIS HEALTH SERVICES | |||||||||||
| 1001 SCOTT AVENUE | MORRIS | MN | 56267 | 237625632 | CAREGIVER | MN | 501C3 | 10 | SFHS | false | |
| PENNINGTON HEALTH SERVICES | |||||||||||
| 2001 EASTWOOD DR | THIEF RIVER FALLS | MN | 56701 | 205617275 | CAREGIVER | MN | 501C3 | 10 | SFHS | false | |
| PRAIRIE COMMUNITY SERVICES | |||||||||||
| 801 NEVADA AVENUE | MORRIS | MN | 56267 | 411598442 | CAREGIVER | MN | 501C3 | 10 | SFHS | false | |
| RENVILLE HEALTH SERVICES | |||||||||||
| 205 SE ELM AVENUE | RENVILLE | MN | 56284 | 202581924 | CAREGIVER | MN | 501C3 | 10 | SFHS | false | |
| ST FRANCIS HEALTH SERVICES (SFHS) | |||||||||||
| 801 NEVADA AVENUE | MORRIS | MN | 56267 | 411484416 | MGMT COMP | MN | 501C3 | 12B | false | N/A | |
| ZUMBROTA HEALTH SERVICES | |||||||||||
| 433 MILL STREET | ZUMBROTA | MN | 55992 | 510487275 | CAREGIVER | MN | 501C3 | 10 | SFHS | false | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| ST FRANCIS HEALTH SERVICES OF MORR | ||
| M | $247,923 | AMOUNT PAID OR ACCRUED |
| ST FRANCIS HEALTH SERVICES OF MORR | ||
| R | $81,692 | AMOUNT PAID OR ACCRUED |
| ST FRANCIS HEALTH SERVICES OF MORR | ||
| E | $911,290 | AMOUNT GUARANTEED |
| ST FRANCIS HEALTH SERVICES OF MORR | ||
| K | $9,176 | AMOUNT PAID OF ACCRUED |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE R | FormAndLineReferenceDesc |
| Explanation | ST. FRANCIS HEALTH SERVICES OF MORRIS, INC HAS GUARANTEED EXISTING LOANS OF 2,045,590 AS SHOWN IN FORM 990, PART X, LINE 20. THERE WERE NO NEW LOAN GUARANTEES DURING THE FISCAL YEAR. ST. FRANCIS HEALTH SERVICES OF MORRIS, INC. HAS AN INTERCOMPANY LOAN OF 450,596 AS SHOWN ON FORM 990, PART X, LINE 24. THE ORGANIZATION HAS PAID 13,923 IN INTEREST TO ST. FRANCIS HEALTH SERVICES OF MORRIS, INC DURING THE YEAR. | ExplanationTxt |
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