NORTHWOOD DEACONESS HEALTH CENTER: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- NORTHWOOD DEACONESS HEALTH CENTER (EIN 45-0226472)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-05-14
- IRS object ID
- 202221349349302507
- 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 | 2022-05-14T16:30:32-04:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Liberty Tax Service | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 720 S Washington St | AddressLine1Txt |
| City | Grand Forks | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 582014328 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450226472 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHWOOD DEACONESS HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | NORT | BusinessNameControlTxt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 190 | AddressLine1Txt |
| City | NORTHWOOD | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58267 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Pete Antonson | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7015876459 | PhoneNum |
| Signature | 2022-06-12 | SignatureDt |
| Discuss With Paid Preparer | false | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Pete | PersonFirstNm |
| Person Last | Antonson | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Brad Ness CPA | PreparerPersonNm |
| PTIN | P00341625 | PTIN |
| Phone | 7017461750 | PhoneNum |
| Preparation | 2022-05-14 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 0 | TrustedCustomerCd |
| OOB Security Verification | 00 | OOBSecurityVerificationCd |
| Authentication Assurance Level | AAL2 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,734,544 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1902 | FormationYr |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Activity Or Mission | Serve as a local access to a full range of health care services. continue as a leader in primary care for the whole family, in care of the elderly, and in emergency services. Function as a focal point for health education and wellness. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 228 | TotalEmployeeCnt |
| Total Volunteers | 27 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $315,015 | PYContributionsGrantsAmt |
| CY Contributions Grants | $421,697 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $15,222,389 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,297,956 | CYProgramServiceRevenueAmt |
| PY Investment Income | $17,458 | PYInvestmentIncomeAmt |
| CY Investment Income | $14,891 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $15,554,862 | PYTotalRevenueAmt |
| CY Total Revenue | $15,734,544 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,811,173 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,395,719 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,792,712 | PYOtherExpensesAmt |
| CY Other Expenses | $4,951,108 | CYOtherExpensesAmt |
| PY Total Expenses | $13,603,885 | PYTotalExpensesAmt |
| CY Total Expenses | $14,346,827 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,950,977 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,387,717 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $12,934,679 | TotalAssetsBOYAmt |
| Total Assets EOY | $11,795,273 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,304,845 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,777,722 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,629,834 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,017,551 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Serve as a local access to a full range of health care services. continue as a leader in primary care for the whole family, in care of the elderly, and in emergency services. Function as a focal point for health education and wellness. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $8,897,950 | ExpenseAmt |
| Revenue | $10,510,026 | RevenueAmt |
| Desc | 1,541 days of acute and swing bed care501 emergency room visits6,495 clinic visits122 ambulance calls5,268 outpatient therapy visits | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,625,842 | ExpenseAmt |
| Revenue | $4,658,830 | RevenueAmt |
| Desc | 10,919 days of nursing home care | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $108,047 | ExpenseAmt |
| Revenue | $129,100 | RevenueAmt |
| Desc | 108 months occupied rentals by tenants | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $12,631,839 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | 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 | false | 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 | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | 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 | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| 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 | false | 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 | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 12 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 228 | 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 |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| DAF Excess Business Holdings | false | DAFExcessBusinessHoldingsInd |
| Taxable Distributions | false | TaxableDistributionsInd |
| Distribution To Donor | false | DistributionToDonorInd |
| 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | 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 | Yes (true) | 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 | ND | StatesWhereCopyOfReturnIsFldCd |
| Own Website | Yes (X) | OwnWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Pete Antonson CEO | PersonNm |
| Phone | 7015876459 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 190 4 N Park St | AddressLine1Txt |
| City | Northwood | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58267 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Key EmployeeKeyEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|---|---|
| Erika Stein | |||||||||
| Family Practice Physician | 40.00 | 0.00 | Yes (X) | $293,022 | $0 | $6,852 | |||
| Condetta Ness | |||||||||
| Nurse Practioner | 40.00 | 0.00 | $274,118 | $0 | $16,174 | Yes (X) | |||
| Brian Twete | |||||||||
| Nurse Practioner | 40.00 | 0.00 | $225,407 | $0 | $18,205 | Yes (X) | |||
| Eric Burke | |||||||||
| Nurse Practioner | 40.00 | 0.00 | $174,511 | $0 | $12,650 | Yes (X) | |||
| Jeanmarie Dahl | |||||||||
| Physician Assistant | 32.00 | 0.00 | $132,417 | $0 | $10,936 | Yes (X) | |||
| Jennifer Metz | |||||||||
| Pharmacy Manager | 32.00 | 0.00 | $112,702 | $0 | $17,899 | Yes (X) | |||
| Peggy Nelson | |||||||||
| Laboratory Manager | 45.00 | 0.00 | $114,531 | $0 | $4,137 | Yes (X) | |||
| Gina Metzler | |||||||||
| LPN | 60.00 | 0.00 | $100,298 | $0 | $9,905 | Yes (X) | |||
| Greg McMahon | |||||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| Patrick Askew | |||||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| Robert Bilden | |||||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| Joan Thompson | |||||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| Cynthia Pic | |||||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| Judy Engen | |||||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| Keith Groven | |||||||||
| President | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| Gary Rankin | |||||||||
| Vice President | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| Lonney Eastvold | |||||||||
| Secretary | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,427,006 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $96,758 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| All Other Contributions | $421,697 | AllOtherContributionsAmt |
| Total Contributions | $421,697 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Hospital | 621400 | $10,510,026 | $10,510,026 |
| Skilled Nursing Facilit | 623000 | $4,658,830 | $4,658,830 |
| Apartments | 623990 | $129,100 | $129,100 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,297,956 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,891 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,891 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,734,544 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,312,847 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,857,678 | TotalAmt |
| Program Services | $7,558,155 | ProgramServicesAmt |
| Management And General | $299,523 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $183,955 | TotalAmt |
| Program Services | $176,943 | ProgramServicesAmt |
| Management And General | $7,012 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $816,325 | TotalAmt |
| Program Services | $785,208 | ProgramServicesAmt |
| Management And General | $31,117 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $537,761 | TotalAmt |
| Program Services | $517,262 | ProgramServicesAmt |
| Management And General | $20,499 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $569,424 | TotalAmt |
| Program Services | $142,200 | ProgramServicesAmt |
| Management And General | $427,224 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $864 | TotalAmt |
| Management And General | $864 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,996 | TotalAmt |
| Management And General | $23,996 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,523 | TotalAmt |
| Management And General | $11,523 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,257 | TotalAmt |
| Management And General | $52,257 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $356,588 | TotalAmt |
| Management And General | $356,588 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,706 | TotalAmt |
| Program Services | $41,377 | ProgramServicesAmt |
| Management And General | $3,329 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,585 | TotalAmt |
| Program Services | $106,204 | ProgramServicesAmt |
| Management And General | $5,381 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $659,631 | TotalAmt |
| Program Services | $659,631 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,671 | TotalAmt |
| Management And General | $115,671 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Utilities | $322,611 | $322,611 | |
| RepairsMaintenance | $252,801 | $252,801 | |
| Food | $135,869 | $135,869 | |
| SuppliesMisc | $2,293,582 | $1,933,578 | $360,004 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,346,827 | TotalAmt |
| Program Services | $12,631,839 | ProgramServicesAmt |
| Management And General | $1,714,988 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,056,993 | BOYAmt |
| EOY | $2,526,998 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,039,881 | BOYAmt |
| EOY | $3,092,721 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,564,000 | BOYAmt |
| EOY | $1,173,179 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,136 | BOYAmt |
| EOY | $50,566 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $17,397,028 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,445,219 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,237,669 | BOYAmt |
| EOY | $4,951,809 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,934,679 | BOYAmt |
| EOY | $11,795,273 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,516,557 | BOYAmt |
| EOY | $3,648,482 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,788,288 | BOYAmt |
| EOY | $2,129,240 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,304,845 | BOYAmt |
| EOY | $5,777,722 | 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 | $4,014,722 | BOYAmt |
| EOY | $5,402,439 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $615,112 | BOYAmt |
| EOY | $615,112 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,629,834 | BOYAmt |
| EOY | $6,017,551 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,934,679 | BOYAmt |
| EOY | $11,795,273 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,387,717 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $70,510 | InvestmentCostOrOtherBasisAmt |
| Book Value | $70,510 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $12,420,205 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $9,753,065 | DepreciationAmt |
| Book Value | $2,667,140 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $4,906,313 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $2,692,154 | DepreciationAmt |
| Book Value | $2,214,159 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,951,809 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $15,734,554 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $15,734,554 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $15,734,554 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $14,346,827 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $14,346,827 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $14,346,827 | TotalExpensesPerForm990Amt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $60,124 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $60,124 | NetCommunityBenefitExpnsAmt |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $423,198 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $382,604 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $40,594 | NetCommunityBenefitExpnsAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $483,322 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $382,604 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $100,718 | NetCommunityBenefitExpnsAmt |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $45,890 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,159 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $43,731 | NetCommunityBenefitExpnsAmt |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $27,500 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,215 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,285 | NetCommunityBenefitExpnsAmt |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,430 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,430 | NetCommunityBenefitExpnsAmt |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 7 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $74,820 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $17,374 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $57,446 | NetCommunityBenefitExpnsAmt |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 9 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $558,142 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $399,978 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $158,164 | NetCommunityBenefitExpnsAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $120,000 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $4,621,397 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,829,360 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$207,963 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | Yes (X) | CostAccountingSystemInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | 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 | Northwood Deaconess Health Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 190 at 4 N Park Street | AddressLine1Txt |
| City | Northwood | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58267 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Facility Reporting Group | 1 | FacilityReportingGroupCd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Northwood Deaconess Health Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.ndhc.net | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.ndhc.net | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.00 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.00 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.ndhc.net | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.ndhc.net | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.ndhc.net | 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 (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Facility Group Part V line 5 | FormAndLineReferenceDesc |
| Explanation | The organization reviews its community health needs assessment regularly. The stratigic planning process takes the assessment into consideration when setting plans, priorities, initiatives and directions. | ExplanationTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 6 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| Northwood Deaconess Health Cen | ||||
| Towner Avenue | Larimore | ND | 58251 | Medical Clinic |
| Northwood Deaconess Health Cen | ||||
| Main St | Binford | ND | 58416 | Medical Clinic |
| Northwood Deaconess Health Cen | ||||
| 4 N Park St | Northwood | ND | 58267 | Medical Clinic |
| Northwood Deaconess Health Cen | ||||
| PO Box 190 at 4 N Park St | Northwood | ND | 58267 | 37 Bed Skilled Nursing Facility |
| Northwood Deaconess Health Cen | ||||
| PO Box 190 at 4 N Park St | Northwood | ND | 58267 | 6 Units Assisted Living Apartments |
| Northwood Deaconess Health Cen | ||||
| PO Box 190 at 4 N Park St | Northwood | ND | 58267 | 10 Units Independent Living Apartments |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 01. Related organization annual community benefit report (Part I, line 6a) | The community benefit report was posted on the website, published locally, and a copy available upon request at no charge. |
| 02. Needs assessment (Part VI, line 2) | As a church owned organization, we maintain contact and communication with our owner churchs through newsletters, meetings, and other various interactions. |
| 03. Patient education (Part VI, line 3) | As a church owned organization, we maintain contact and communication with our owner churchs through newsletters, meetings, and other various interactions. |
| 04. Community information (Part VI, line 4) | We serve the southwest portion of Grand Forks County, eastern Nelson County, and parts of Steele, Traill and Griggs Counties. The entire area is by definition rural with a total population of approximately 9,600. |
| 05. Promoting community health (Part VI, line 5) | We participate in health fairs for the public on health issues. Due to Covid 19, these were not help this past year. We hold wellness clinics for both men and women specializing in their individual needs. We maintain a community fitness centerat a fee that is subsidized to the patrons in order to ensure it is affordable and accessible. Access to the fitness center was limited for significant parts of the year due to Covid 19 pandemic. |
| 06. Collection practices (Part III, line 9b) | The Health Center offers a charity care financial assistance program and make it known to clients. If clients do not qualify or apply they can make payments on account. After 180 days, accounts with no payment activity are turned over to collection agency. |
| 07. Subsidized health services costs (Part I, line 7g) | Meals on Wheels revenue $504 expenses $1108 net loss $604Foot Care revenue $1431 expenses $2190 net loss $759Medicare Alert Units revenue $13280 expenses $24202 net loss $10922 |
| 08. Costing methodology explanation (Part I, line 7) | The Health Center uses an audited cost accounting system to accumulated costs associated with other community benefit programs. |
| 09. Part III, line 2 | Patient and resident accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectibility of accounts receivable, the Health Center analyzes its past history and identifies trends for each of its major payor sources to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with self pay patients, the Health Center records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill that is self pay. |
| 10. Allowable Medicare costing methodology (Part III, line 8) | The Health Center uses an audited cost accounting system to accumulated costs associated with Medicare billings. |
| 11. Other charity care criteria description (Part I, line 3c) | The Health Center uses FPG in determining eligibilty for free or discounted care. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|
| Eric Burke | ||||
| Nurse Practioner | $174,511 | $5,798 | $6,852 | $187,161 |
| Condetta Ness | ||||
| Nurse Practioner | $274,118 | $8,662 | $7,512 | $290,292 |
| Brian Twete | ||||
| Nurse Practioner | $225,407 | $7,333 | $10,872 | $243,612 |
| Erika Stein | ||||
| Family Practice Physician | $293,022 | $6,852 | $299,874 | |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990 governing body review Part VI line 11 | The tax return is provided to all members of the governing board with related schedules prior to the return beign filed. The return is on the agendaof a regularly scheduled board meeting, mailed one week prior to the meeting, and reviewed at the board meeting. |
| Conflict of interest policy compliance Part VI line 12c | The policy is reviewed by the board of directors and management team annually. Examples of what a conflict of interest or conflicted person are reviewed. Each person must sign and acknowladge understandingof the policy. |
| CEO executive director top management comp Part VI line 15a | We are managed by Sanford Health with the CEO being employed by Sanford Health. Sanford Health uses regional salary data to set their scale and suggests salary for the CEO to the board of directors. |
| Other officer or key employee compensation Part VI line 15b | The facility uses statewide data surveyed by the ND Hospital Association and the ND Long Term Care Association when administering salaries. Policy is to be competitive regionally. |
| Governing documents etc available to public Part VI line 19 | The financial statements, conflict of interest policy and governing documents are available upon request. |
Comments