INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSN: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSN (EIN 41-0726171)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-09
- IRS object ID
- 202143139349302284
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-09T14:26:14-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410726171 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INTERNATIONAL FALLS MEMORIAL | BusinessNameLine1Txt |
| Business Name Line2 | HOSPITAL ASSOCIATION | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | INTE | BusinessNameControlTxt |
| Phone | 2182835431 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 HIGHWAY 71 | AddressLine1Txt |
| City | INTERNATIONAL FALLS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56649 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MELISSA MARCOTTE | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 2182835431 | PhoneNum |
| Signature | 2021-11-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MELISSA | PersonFirstNm |
| Person Last | MARCOTTE | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2021-11-03 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 0 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RAINY LAKE MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ROBERT PASTOR II | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 HIGHWAY 71 | AddressLine1Txt |
| City | INTERNATIONAL FALLS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56649 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $31,278,514 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.RAINYLAKEMEDICAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1945 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | TO PROMOTE AND PROVIDE HEALTH CARE AND WELLNESS SERVICES IN OUR REGION THAT EXCEED EXPECTATIONS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 229 | TotalEmployeeCnt |
| Total Volunteers | 29 | TotalVolunteersCnt |
| Total Gross UBI | $925 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $374,183 | PYContributionsGrantsAmt |
| CY Contributions Grants | $82,823 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $29,129,592 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $29,990,698 | CYProgramServiceRevenueAmt |
| PY Investment Income | $56,497 | PYInvestmentIncomeAmt |
| CY Investment Income | $325,791 | CYInvestmentIncomeAmt |
| PY Other Revenue | $63,588 | PYOtherRevenueAmt |
| CY Other Revenue | $348,015 | CYOtherRevenueAmt |
| PY Total Revenue | $29,623,860 | PYTotalRevenueAmt |
| CY Total Revenue | $30,747,327 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $20,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $14,164,682 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $14,668,570 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $14,835,970 | PYOtherExpensesAmt |
| CY Other Expenses | $14,849,834 | CYOtherExpensesAmt |
| PY Total Expenses | $29,000,652 | PYTotalExpensesAmt |
| CY Total Expenses | $29,538,404 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $623,208 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,208,923 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $26,822,079 | TotalAssetsBOYAmt |
| Total Assets EOY | $38,929,757 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,221,433 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $21,534,050 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $16,600,646 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $17,395,707 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | PROVIDE ACCESSIBLE QUALITY HEALTHCARE TO OUR COMMUNITIES USING VALUES OF INTEGRITY AND RESPECT, COMPASSION AND EXCELLENCE THROUGH TEAMWORK (ICE) IN SUPPORT OF THE VISION COMPRISED OF THE FOLLOWING ELEMENTS: PROVIDER OF CHOICE OF OUR COMMUNITIES, PATIENT AND FAMILY-CENTERED CARE, EXPANDING SERVICES, REGIONAL SPECIALTY RELATIONSHIPS AND PREFERRED HEALTHCARE EMPLOYER. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $23,577,067 | ExpenseAmt |
| Grant | $20,000 | GrantAmt |
| Revenue | $30,167,752 | RevenueAmt |
| Desc | PROVIDED HEALTH CARE SERVICES TO THE COMMUNITY OF INTERNATIONAL FALLS AND SURROUNDING AREA. IN ADDITION TO PROVIDING DIRECT PATIENT CARE AND IN FURTHERANCE OF ITS CHARITABLE PURPOSE, RAINY LAKE MEDICAL CENTER (RLMC) PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY INCLUDING OFFERING VARIOUS COMMUNITY BASED SERVICE PROGRAMS, CASH CONTRIBUTIONS TO NON-PROFIT AGENCIES, THE DONATION OF SPACE FOR USE BY COMMUNITY GROUPS, AND STAFF TIME TO MENTORING/JOB SHADOWING. ADDITIONALLY, A NUMBER OF HEALTH-RELATED EDUCATION PROGRAMS ARE PROVIDED FOR THE BENEFIT OF THE COMMUNITY, INCLUDING HEALTH ENHANCEMENTS AND WELLNESS, CLASSES ON SPECIFIC CONDITIONS, AND PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. RLMC ALSO ACTIVELY PROMOTES ITS COMMUNITY CARE PROGRAM, WHICH PROVIDES FREE OR REDUCED COST HEALTHCARE TO PATIENTS WHO ARE UNABLE TO PAY FULLY FOR SERVICES RECEIVED.THE DECISION WAS MADE TO SUSPEND OB SERVICES AT RLMC HOSPITAL. | Desc |
| Total Program Service Expenses | $23,577,067 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 74 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 229 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MELISSA MARCOTTE CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2182835431 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 HIGHWAY 71 | AddressLine1Txt |
| City | INTERNATIONAL FALLS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56649 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| DANIEL MARGO | ||||||||
| GENERAL SURGEON | 20.00 | Yes (X) | $307,747 | $0 | $28,828 | |||
| JAY KNAAK | ||||||||
| PHYSICIAN | 40.00 | Yes (X) | $264,230 | $0 | $35,960 | |||
| DAVID MOYER | ||||||||
| PHYSICIAN | 40.00 | Yes (X) | $208,728 | $0 | $7,788 | |||
| JULIE DOLPHIN | ||||||||
| HOSPITALIST | 40.00 | Yes (X) | $176,828 | $0 | $12,437 | |||
| KATIE CHEZICK | ||||||||
| PHARMACIST | 40.00 | Yes (X) | $158,628 | $0 | $17,395 | |||
| ROBERT PASTOR II | ||||||||
| CEO | 40.00 | $276,948 | $0 | $24,189 | 1.00 | Yes (X) | ||
| MELISSA MARCOTTE | ||||||||
| CFO | 40.00 | $164,048 | $0 | $3,475 | 1.00 | Yes (X) | ||
| RICHARD PETERSON | ||||||||
| CHAIR | 4.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| JON TALSNESS | ||||||||
| VICE CHAIR | 4.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| STEVEN LINDBERG | ||||||||
| TREASURER | 4.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| BRIAN BRIGGS | ||||||||
| SECRETARY | 4.00 | $0 | $0 | $0 | Yes (X) | |||
| SUSAN CONGRAVE | ||||||||
| MEMBER | 4.00 | $0 | $0 | $0 | Yes (X) | |||
| SHERRI MANNAUSAU | ||||||||
| MEMBER | 4.00 | $0 | $0 | $0 | Yes (X) | |||
| DON BILLIG | ||||||||
| MEMBER | 4.00 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,557,157 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $130,072 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 30 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ACUTE CARE INC | |||||
| 1609 N ANKENY BLVD SUITE 200 | ANKENY | IA | 50023 | PHYSICIAN FEES | $1,765,662 |
| R C SHEFLAND ANESTHESIA LTD | |||||
| 27040 CTY RD 9 | BEMIDJI | MN | 56601 | ANESTHESIOLOGIST FEES | $503,104 |
| SANFORD HEALTH | |||||
| PO BOX 5074 | SIOUX FALLS | SD | 57117 | PROVIDING MEAL SERVICE AND SOFTWARE MAIN | $395,109 |
| SANFORD LABORATORIES | |||||
| PO BOX 5056 | SIOUX FALLS | SD | 57117 | LAB TESTING SERVICE | $352,652 |
| CPSIEVIDENT | |||||
| PO BOX 850309 | MOBILE | AL | 36685 | FACILITY WIDE COMPUTER SYSTEM, MAINTENAN | $286,113 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 17 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $60,850 | RelatedOrganizationsAmt |
| All Other Contributions | $21,973 | AllOtherContributionsAmt |
| Total Contributions | $82,823 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $29,533,259 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $29,533,259 | RelatedOrExemptFuncIncomeAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $457,439 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $456,514 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $925 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $29,990,698 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $145,820 | TotalRevenueColumnAmt |
| Exclusion | $145,820 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $63,057 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $63,057 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $63,057 | TotalRevenueColumnAmt |
| Exclusion | $63,057 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $711,158 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $526,215 | SecuritiesAmt |
| Other | $4,972 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $184,943 | SecuritiesAmt |
| Other | -$4,972 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $179,971 | TotalRevenueColumnAmt |
| Exclusion | $179,971 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CMDI EARNINGS | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $177,979 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $177,979 | RelatedOrExemptFuncIncomeAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $106,979 | TotalRevenueColumnAmt |
| Exclusion | $106,979 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $284,958 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,747,327 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $30,167,752 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $925 | UnrelatedBusinessRevenueAmt |
| Exclusion | $495,827 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,000 | TotalAmt |
| Program Services | $20,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $468,661 | TotalAmt |
| Management And General | $468,661 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,652,366 | TotalAmt |
| Program Services | $9,480,426 | ProgramServicesAmt |
| Management And General | $2,171,940 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $152,568 | TotalAmt |
| Program Services | $119,048 | ProgramServicesAmt |
| Management And General | $33,520 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,526,714 | TotalAmt |
| Program Services | $993,094 | ProgramServicesAmt |
| Management And General | $533,620 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $868,261 | TotalAmt |
| Program Services | $793,477 | ProgramServicesAmt |
| Management And General | $74,784 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,121 | TotalAmt |
| Management And General | $34,121 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,513 | TotalAmt |
| Management And General | $36,513 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,763,311 | TotalAmt |
| Program Services | $4,229,956 | ProgramServicesAmt |
| Management And General | $533,355 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $163,936 | TotalAmt |
| Program Services | $134,455 | ProgramServicesAmt |
| Management And General | $29,481 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $87,903 | TotalAmt |
| Program Services | $70,581 | ProgramServicesAmt |
| Management And General | $17,322 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $345,002 | TotalAmt |
| Program Services | $224,063 | ProgramServicesAmt |
| Management And General | $120,939 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,487 | TotalAmt |
| Program Services | $17,852 | ProgramServicesAmt |
| Management And General | $9,635 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,358 | TotalAmt |
| Program Services | $1,531 | ProgramServicesAmt |
| Management And General | $827 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $261,910 | TotalAmt |
| Program Services | $170,098 | ProgramServicesAmt |
| Management And General | $91,812 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,504,923 | TotalAmt |
| Program Services | $977,378 | ProgramServicesAmt |
| Management And General | $527,545 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $125,348 | TotalAmt |
| Program Services | $81,408 | ProgramServicesAmt |
| Management And General | $43,940 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $4,241,954 | $3,711,933 | $530,021 |
| EQUIPMENT RENTAL | $828,210 | $537,884 | $290,326 |
| REPAIRS & MAINTENANCE | $665,559 | $432,250 | $233,309 |
| BAD DEBT EXPENSE | $636,014 | $636,014 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,125,285 | TotalAmt |
| Program Services | $945,619 | ProgramServicesAmt |
| Management And General | $179,666 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,538,404 | TotalAmt |
| Program Services | $23,577,067 | ProgramServicesAmt |
| Management And General | $5,961,337 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $90,427 | BOYAmt |
| EOY | $12,377 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,742,961 | BOYAmt |
| EOY | $13,550,500 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,986,322 | BOYAmt |
| EOY | $3,349,885 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $572,729 | BOYAmt |
| EOY | $665,866 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $146,179 | BOYAmt |
| EOY | $653,579 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $27,673,598 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $14,427,095 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,400,063 | BOYAmt |
| EOY | $13,246,503 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,146,629 | BOYAmt |
| EOY | $6,754,071 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $736,769 | BOYAmt |
| EOY | $670,623 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $26,353 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,822,079 | BOYAmt |
| EOY | $38,929,757 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,298,914 | BOYAmt |
| EOY | $2,357,209 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $4,437,328 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,507,233 | BOYAmt |
| EOY | $6,595,151 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $415,286 | BOYAmt |
| EOY | $8,144,362 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,221,433 | BOYAmt |
| EOY | $21,534,050 | 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 | $16,509,294 | BOYAmt |
| EOY | $17,287,447 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $91,352 | BOYAmt |
| EOY | $108,260 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,600,646 | BOYAmt |
| EOY | $17,395,707 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,822,079 | BOYAmt |
| EOY | $38,929,757 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,208,923 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$95,751 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$318,111 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $498 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $498 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION PAYS DUES TO VARIOUS PROFESSIONAL ORGANIZATIONS. A PORTION OF THESE DUES ARE USED TOWARDS LOBBYING EXPENSES. THE LOBBYING EXPENSES GO TOWARDS ADVOCATING FOR THE ORGANIZATION'S PURPOSE AND MISSION. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $87,371 | OtherCostOrOtherBasisAmt |
| Book Value | $87,371 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,804,170 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,071,014 | DepreciationAmt |
| Book Value | $10,733,156 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,315,833 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,356,081 | DepreciationAmt |
| Book Value | $1,959,752 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $466,224 | OtherCostOrOtherBasisAmt |
| Book Value | $466,224 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $13,246,503 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| PAYROLL PROTECTION PROGRAM LOAN PAYABLE | $2,337,500 |
| DEFERRED COMPENSATION PLAN LIABILITIES | $26,353 |
| ESTIMATED THIRD PARTY PAYOR SETTLEMENTS | $5,761,959 |
| OTHER ACCRUED LIABILITIES | $18,550 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $8,144,362 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $72,981 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $72,981 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00250 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $711,263 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $341,114 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $370,149 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01280 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $784,244 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $341,114 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $443,130 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01530 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,088 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $11,088 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,635 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $12,635 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,420,206 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,317,189 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,103,017 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.17660 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $575 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $575 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,444,504 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,317,189 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,127,315 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.17740 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,228,748 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,658,303 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,570,445 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.19270 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $46,827 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $46,827 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,250 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $20,250 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $67,077 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $67,077 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00230 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $368,888 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $8,843,058 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,796,815 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $46,243 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RAINY LAKE MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 HIGHWAY 71 | AddressLine1Txt |
| City | INTERNATIONAL FALLS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56649 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.RAINYLAKEMEDICAL.COM | WebsiteAddressTxt |
| State License | 394716 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | 2 RURAL HEALTH CLINICS/SPECIALTY PROVIDER-BASED CLINIC | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RAINY LAKE MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SUPPLEMENTAL INFORMATION | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE SUPPLEMENTAL INFORMATION | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.RAINYLAKEMEDICAL.COM/PATIENT-RESOURCES/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.RAINYLAKEMEDICAL.COM/PATIENT-RESOURCES/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.RAINYLAKEMEDICAL.COM/PATIENT-RESOURCES/ | 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 |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| RAINY LAKE MEDICAL CENTER | PART V, SECTION B, LINE 5: IN ADDITION TO GATHERING DATA FROM SECONDARY SOURCES, A CHNA SURVEY WAS DEPLOYED TO OUR LOCAL EXPERT ADVISORS TO GAIN INPUT ON LOCAL HEALTH NEEDS AND THE NEEDS OF PRIORITY POPULATIONS. COMMUNITY INPUT FROM 25 LOCAL EXPERT ADVISORS WAS RECEIVED. SURVEY RESPONSES STARTED SEPTEMBER 22ND, 2019 AND ENDED ON OCTOBER 14TH, 2019. HAVING TAKEN STEPS TO IDENTIFY POTENTIAL COMMUNITY NEEDS, THE LOCAL EXPERTS THEN PARTICIPATED IN A STRUCTURED COMMUNICATION TECHNIQUE CALLED A "WISDOM OF CROWDS" METHOD WHERE EACH LOCAL EXPERT HAD THE OPPORTUNITY TO INTRODUCE NEEDS PREVIOUSLY UNIDENTIFIED AND TO CHALLENGE CONCLUSIONS DEVELOPED FROM THE DATA ANALYSIS. A LIST OF ALL NEEDS IDENTIFIED BY ANY OF THE ANALYZED DATA WAS DEVELOPED. THE LOCAL EXPERTS THEN ALLOCATED 100 POINTS AMONG THE LIST OF HEALTH NEEDS, INCLUDING THE OPPORTUNITY TO LIST ADDITIONAL NEEDS THAT WERE NOT IDENTIFIED FROM THE DATA. THE RANKED NEEDS WERE DIVIDED INTO TWO GROUPS: "SIGNIFICANT AND "OTHER IDENTIFIED NEEDS." THE LOCAL EXPERT ADVISORS WERE ASKED TO SELF IDENTIFY THEMSELVES INTO ANY REPRESENTATIVE CLASSIFICATIONS WITH THE FOLLOWING RESULTS: PUBLIC HEALTH EXPERTISE (8) DEPARTMENTS AND AGENCIES WITH RELEVANT DATA/INFORMATION REGARDING HEALTH NEEDS (8) PRIORITY POPULATIONS (12) REPRESENTATIVE/ MEMBER OF CHRONIC DISEASE GROUP OR ORGANIZATION (3) REPRESENTS THE BROAD INTEREST OF THE COMMUNITY (21). |
| RAINY LAKE MEDICAL CENTER | PART V, SECTION B, LINE 6B: QUORUM HEALTH RESOURCES ASSISTED WITH THE DEVELOPMENT OF RLMC'S COMMUNITY HEALTH NEEDS ASSESSMENT. |
| RAINY LAKE MEDICAL CENTER | PART V, SECTION B, LINE 11: THE FOLLOWING NEEDS WERE IDENTIFIED IN THE MOST RECENTLY CONDUCTED CHNA:- HEALTHCARE AFFORDABILITY/ACCESSIBILITY- MENTAL HEALTH- HEALTHCARE EDUCATION/PREVENTATIVE CARE- EMERGENCY ROOM SERVICES- DRUG/SUBSTANCE/ALCOHOL ABUSE- OBESITY/OVERWEIGHTTHE ORGANIZATION WILL NOT ADDRESS THE FOLLOWING NEEDS IDENTIFIED IN ITS MOST RECENT CHNA BECAUSE OF RESOURCE CONSTRAINTS AND THE AVAILABILITY OF OTHER RESOURCES IN THE COMMUNITY:- MENTAL HEALTH;- DRUG/SUBSTANCE/ALCOHOL ABUSE: DUE TO THE SIMILAR SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO ADDRESS THESE THREE NEEDS, WE GROUPED THESE NEEDS TOGETHER. - OBESITY/OVERWEIGHT.IN THE CURRENT YEAR THE FACILITY HAS TAKEN THE FOLLOWING ACTIONS TO ADDRESS HEALTHCARE AFFORDABILITY/ACCESSIBILITY, HEALTHCARE EDUCATION/PREVENTATIVE CARE, AND EMERGENCY ROOM SERVICES:- 16 HYPERTENSIVE PATIENTS WITH ELEVATED B/P WERE FOLLOWED IN 2020 AND LOANED A CUFF FOR ONE OR MORE TWO WEEK MONITORING PERIODS. THE RESULTS WERE MONITORED BY THE POPULATION HEALTH NURSE EVERY 2 WEEKS AND THE PCP WAS PROVIDED THE RESULTS AT THE END OF THE MONITORING PERIOD OR SOONER IF NEEDED. - 43 DIABETIC PATIENTS WERE FOLLOWED IN 2020 TO PROVIDE EDUCATION ON DIABETES MANAGEMENT, OVERSITE OF BLOOD SUGAR RESULTS, A1C GOALS, DIETARY EDUCATION AND FOOD DIARY MONITORING. PCP RECEIVED REPORTS OF PATIENT PROGRESS VIA EMR DOCUMENTATION AND REPORTING IN PERSON AS NEEDED. - AN RFP WAS CREATED AND DISTRIBUTED IN 2020 TO SEVERAL ER STAFFING COMPANIES. OUR CURRENT PROVIDER SUBMITTED THE MOST FAVORABLE RESPONSE SO RLMC ENTERED INTO SUCCESSFUL BUT PROLONGED NEGOTIATIONS TO BRING ABOUT A NUMBER OF CONTRACTUAL CHANGES TO IMPROVE THE QUALITY OF THE SERVICE PROVIDED. - DURING 2020 CONTRACT RENEWAL NEGOTIATIONS, RLMC WAS ABLE TO NEGOTIATE FOR THE ABILITY TO STAFF THE ER WITH LOCAL PROVIDERS AT OUR OPTION WITHOUT ADDITIONAL CHARGES.- IN THE SPRING OF 2020, THE ED STAFFING COMPANY WORKED WITH THE SULLIVAN GROUP TO DELIVER PATIENT SATISFACTION TRAINING FOR THEIR PROVIDERS. IN ADDITION, THE STAFFING COMPANY HAS UNDERTAKEN QUALITY INITIATIVES TO TRAIN THEIR PROVIDERS ON MANAGING UP AND SCRIPTING TO DELIVER KEY WORDS AT THE END OF THE ED VISIT. THE STAFFING COMPANY'S CMO IS PERFORMING MONTHLY RANDOM CHART REVIEWS TO ASSESS AND IMPROVE THE QUALITY OF THEIR PROVIDER'S DOCUMENTATION. RLMC IS SHARING ED PROVIDER-SPECIFIC SATISFACTION DATA AND PATIENT SURVEY COMMENTS WITH THE ED PROVIDERS. |
| RAINY LAKE MEDICAL CENTER | PART V, SECTION B, LINE 15E: THE CONTACT PHONE NUMBER IS LISTED ON THE WEBSITE AND PROVIDED IN ALL STATEMENTS AND LETTERS MAILED, AND A BUSINESS CARD IS INCLUDED IN THE APPLICATION PACKET. |
| RAINY LAKE MEDICAL CENTER | PART V, SECTION B, LINE 16J: WORK CLOSELY WITH COUNTY SERVICES AND COMMUNITY SENIOR ADVOCATE. |
| SCHEDULE H, PART V, LINE 7A | PART V, LINE 7A:HTTPS://WWW.RAINYLAKEMEDICAL.COM/WP-CONTENT/UPLOADS/2020/09/RLMC-2019-CHNA.PDF |
| SCHEDULE H, PART V, LINE 10A | PART V, LINE 10A:HTTPS://WWW.RAINYLAKEMEDICAL.COM/WP-CONTENT/UPLOADS/2016/06/IMPLEMENTATION-STRATEGY-1.PDF |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 636,014. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | RAINY LAKE MEDICAL CENTER SUPPORTS EFFORTS TO ENSURE THE SAFE REMOVAL AND TREATMENT OF GARBAGE AND WASTE PRODUCTS. RAINY LAKE MEDICAL CENTER ALSO PROVIDES SUPPORT TO AN EDUCATIONAL INSTITUTION IN THE AREA TO HELP TRAIN HEALTH PROFESSIONALS. |
| PART III, LINE 2: | THE AMOUNT REPORTED ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THE RESPECTIVE CLASS OF PATIENTS. |
| PART III, LINE 3: | THE HOSPITAL DOES NOT HAVE A WAY TO REASONABLY ESTIMATE THE AMOUNT OF IMPLICIT PRICE CONCESSIONS THAT ARE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE. |
| PART III, LINE 4: | SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. BAD DEBT EXPENSE FOR THE YEARS ENDED DECEMBER 31, 2020 AND 2019, WAS NOT SIGNIFICANT. |
| PART III, LINE 8: | RLMC IS A CRITICAL ACCESS HOSPITAL. THERE WAS A SURPLUS IN 2020, HOWEVER, REGARDLESS OF SHORTFALL OR SURPLUS, THE HOSPITAL PROVIDES SERVICES TO THESE PATIENTS BECAUSE ACCESS TO HEALTHCARE AND INDIVIDUAL'S HEALTH IS IMPORTANT TO THE HOSPITAL. MEDICARE ALLOWABLE COSTS WERE OBTAINED FROM THE 2020 MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. |
| PART III, LINE 9B: | RLMC WILL NOT REFER AN ACCOUNT TO A THIRD-PARTY DEBT COLLECTION AGENCY UNLESS RLMC HAS GIVEN THE PATIENT REASONABLE OPPORTUNITY TO SUBMIT A FINANCIAL ASSISTANCE APPLICATION IF THE FACTS AND CIRCUMSTANCES SUGGEST THE PATIENT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. INCLUDING FOR EXAMPLE, IF THE PATIENT IS UNINSURED OR IS ON MINNESOTA CARE, MEDICAL ASSISTANCE, OR OTHER RELIEF BASED ON NEED. IF A PATIENT SUBMITS AN APPLICATION FOR FINANCIAL ASSISTANCE AFTER AN ACCOUNT HAS BEEN REFERRED FOR COLLECTION ACTIVITY, RLMC WILL SUSPEND ALL COLLECTION ACTIVITY UNTIL THE PATIENT'S APPLICATION HAS BEEN PROCESSED AND THE PATIENT HAS BEEN NOTIFIED OF THE DECISION. |
| PART VI, LINE 2: | IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT COMPLETED EVERY 3 YEARS, COMMUNITY HEALTH FAIRS ARE HELD WHERE COMMUNITY MEMBERS CAN PROVIDE FEEDBACK ON THEIR HEALTH CARE NEEDS. A PATIENT & FAMILY ADVISORY COUNCIL (PFAC) HAS ALSO BEEN FORMED WHICH PROVIDES A LINK BETWEEN THE COMMUNITY AND THE ORGANIZATION. RLMC ALSO HAS REPRESENTATION AT THE QUARTERLY COMMUNITY MENTAL HEALTH MEETING, WHICH ALSO INCLUDES SOCIAL SERVICES, LOCAL MENTAL HEALTH PROVIDERS AND LAW ENFORCEMENT. THE GOAL OF THE GROUP IS TO SHARE RESOURCES AND ADDRESS THE LOCAL MENTAL HEALTH NEEDS. |
| PART VI, LINE 3: | RLMC HAS STAFF THAT ARE CERTIFIED MNSURE NAVIGATORS, WHICH ENABLES US TO ASSIST OUR PATIENTS IN COMPLETING THE APPLICATION PROCESS ON THE HEALTH EXCHANGE TO SEE IF THEY QUALIFY FOR INSURANCE OR A MEDICAID PLAN. RLMC COMMUNICATES OUR FINANCIAL ASSISTANCE PROGRAM TO PATIENTS IN THE FOLLOWING MANNER: 1. PATIENTS ARE GIVEN A FINANCIAL ASSISTANCE BROCHURE WITH A MNSURE HEALTH EXCHANGE INSERT AT THE TIME OF SERVICE. 2. STATEMENTS AND LETTERS ARE SENT TO PATIENTS OFFERING FINANCIAL ASSISTANCE. 3. PHONE CALLS ARE MADE TO PATIENTS TO DISCUSS AND OFFER FINANCIAL ASSISTANCE AND ASSISTANCE WITH THE MNSURE APPLICATION PROCESS. 4. ALL EMPLOYEES ARE EDUCATED ANNUALLY ABOUT OUR FINANCIAL ASSISTANCE PROGRAM AND THREE EMPLOYEES ARE EDUCATED TO COMPLETE AND SUBMIT MNSURE APPLICATIONS TO THE STATE FOR PROCESSING. 5. UPON REQUEST, FINANCIAL ASSISTANCE PACKETS WITH APPLICATIONS FOR BOTH OUR FINANCIAL ASSISTANCE PROGRAM AND THE MNSURE PROGRAM ARE SENT OR GIVEN TO PATIENTS. 6. THE RLMC WEBSITE DISPLAYS PAYMENT OPTIONS WHERE OUR FINANCIAL ASSISTANCE PROGRAM IS DISCUSSED. 7. ONE OF THE REQUIREMENTS FOR RLMC FINANCIAL ASSISTANCE IS A DENIAL FROM THE COUNTY IN REGARD TO FINANCIAL ASSISTANCE UNLESS THEY ARE ENROLLED IN THE MN SENIOR PROGRAM. WE OFFER TO ASSIST THEM WITH THEIR MEDICAL ASSISTANCE APPLICATION. 8. SIGNAGE COMMUNICATING THE PROGRAM TO PATIENTS IS DISPLAYED IN MANY AREAS OF THE PATIENT CARE AREA OF THE FACILITY. 9. FINANCIAL COUNSELORS ATTEND HEALTH FAIRS AND OTHER EVENTS IN THE COMMUNITY TO PROMOTE THE PROGRAM AND ANSWER ANY QUESTIONS. 10. RLMC HAS PARTNERED WITH NUMEROUS COMMUNITY SERVICE PARTNERS TO PROMOTE OUR FINANCIAL ASSISTANCE PROGRAM AND MNSURE NAVIGATOR AVAILABILITY. THE COMMUNITY SERVICE PARTNERS ARE GIVEN FINANCIAL ASSISTANCE AND MNSURE INFORMATION TO SHARE WITH THEIR PATRONS AND BUSINESS CARDS OF OUR FINANCIAL COUNSELING STAFF. RLMC STAFF MEETS WITH OUR SERVICE PARTNERS FOR INPUT REGARDING OUR PROGRAMS, TO REPLENISH BROCHURES AND INFORMATION AND TO UPDATE THEM WITH ANY CHANGES. |
| PART VI, LINE 4: | RLMC'S PRIMARY SERVICE AREA (PSA) IS KOOCHICHING COUNTY, MINNESOTA. THE COUNTY IS LARGE AND SPARSELY POPULATED (LESS THAN 4.3 PERSONS PER SQUARE MILE) WITH MOST OF THE POPULATION CENTERED IN INTERNATIONAL FALLS. OTHER NEARBY COMMUNITIES INCLUDE LITTLEFORK, BIG FALLS, RANIER, BIRCHDALE AND LOMAN. THE PSA HAS AN ESTIMATED POPULATION OF LESS THAN 13,000 AND POPULATION DECLINE IS PROJECTED TO CONTINUE WHILE THE NUMBER OF PERSONS OVER 65 IS EXPECTED TO RISE EVEN MORE. |
| PART VI, LINE 5: | REPRESENTATION ON THE BOARD OF TRUSTEES IS 100% LOCAL AS ALL TRUSTEES ARE ACTIVE AND INVOLVED MEMBERS OF THE LOCAL COMMUNITY. RLMC HAS IN PLACE AN OPEN MEDICAL STAFF MODEL AND HAS SPECIALISTS FROM SEVERAL DIFFERENT HEALTH CARE SYSTEMS PROVIDING CARE TO PATIENTS. THE ORGANIZATION HAS RECENTLY INVESTED OVER $8 MILLION IN EXPANSION AND RENOVATION OF THE CURRENT FACILITY IN ORDER TO PROVIDE BETTER PATIENT CARE AND MORE LOCAL CARE, ELIMINATING THE NEED TO TRAVEL 100+ MILES TO RECEIVE CARE. THE ORGANIZATION ALSO CONTINUES TO EXPAND THE BREADTH OF SPECIALTY SERVICES OFFERED LOCALLY ON AN OUTREACH BASIS. EMERGENCY SERVICES ARE OFFERED 24/7, 365 DAYS A YEAR TO ALL NEEDING CARE. BECAUSE OF ITS REMOTE LOCATION, IF SERVICES OF CHEMOTHERAPY AND LABOR/DELIVERY WERE NOT OFFERED IN THE COMMUNITY, RESIDENTS WOULD HAVE TO TRAVEL 100+ MILES TO RECEIVE THESE CRITICAL SERVICES. THE ORGANIZATION RECENTLY ESTABLISHED A PATIENT & FAMILY ADVISORY COUNCIL (PFAC) TO ALLOW FOR COMMUNITY INPUT. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | MN |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RAINY RIVER COMMUNITY COLLEGE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1501 HIGHWAY 71 | AddressLine1Txt |
| City | INTERNATIONAL FALLS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56649 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 411687554 | RecipientEIN |
| IRC Section | GOVERNMENT | IRCSectionDesc |
| Cash Grant | $20,000 | CashGrantAmt |
| Purpose Of Grant | SUPPORT FOR NURSING PROGRAM AT RRCC | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL DOES NOT SEEK APPLICANTS FOR GRANTS, NOR DOES IT ACTIVELY ENGAGE IN GRANT MAKING. HOWEVER, THERE WAS A NEED LOCALLY THAT THE HOSPITAL DEDICATED DOLLARS TO SUPPORTING DURING THE YEAR. FROM TIME TO TIME, THE HOSPITAL MAY ENGAGE IN DIALOGUE WITH THE COMMUNITY COLLEGE, HOWEVER, THEY DO NOT INTEND TO MONITOR THE USE OF FUNDS IN DETAIL OR FORMALLY. THE GIFT WAS RESTRICTED TO SUPPORT THE NURSING PROGRAM BUT WILL OTHERWISE BE CONSIDERED GENERAL SUPPORT. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Written Policy Ref T And E Expnss | 0 | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | 0 | SubstantiationRequiredInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DANIEL MARGO | ||||||||||||||
| GENERAL SURGEON | $307,603 | $0 | $144 | $0 | $0 | $0 | $5,700 | $0 | $23,128 | $0 | $336,575 | $0 | $0 | $0 |
| JAY KNAAK | ||||||||||||||
| PHYSICIAN | $258,312 | $0 | $5,144 | $0 | $774 | $0 | $4,953 | $0 | $31,007 | $0 | $300,190 | $0 | $0 | $0 |
| DAVID MOYER | ||||||||||||||
| PHYSICIAN | $207,812 | $0 | $142 | $0 | $774 | $0 | $1,077 | $0 | $6,711 | $0 | $216,516 | $0 | $0 | $0 |
| JULIE DOLPHIN | ||||||||||||||
| HOSPITALIST | $176,286 | $0 | $142 | $0 | $400 | $0 | $785 | $0 | $11,652 | $0 | $189,265 | $0 | $0 | $0 |
| KATIE CHEZICK | ||||||||||||||
| PHARMACIST | $145,095 | $0 | $5,076 | $0 | $8,457 | $0 | $3,158 | $0 | $14,237 | $0 | $176,023 | $0 | $0 | $0 |
| ROBERT PASTOR II | ||||||||||||||
| CEO | $266,134 | $0 | $10,544 | $0 | $270 | $0 | $5,134 | $0 | $19,055 | $0 | $301,137 | $0 | $0 | $0 |
| MELISSA MARCOTTE | ||||||||||||||
| CFO | $152,110 | $0 | $5,860 | $0 | $6,078 | $0 | $3,176 | $0 | $299 | $0 | $167,523 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 1A | FormAndLineReferenceDesc |
| Explanation | DISCRETIONARY COVID BONUS PAID TO ALL EMPLOYEES IN 2020 WAS GROSSED UP. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ANDREA PASTOR | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | FAMILY MEMBER OF CEO | RelationshipDescriptionTxt |
| Transaction | $51,145 | TransactionAmt |
| Transaction | EMPLOYEE/COMPENSATION | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY THE SAME ACCOUNTING FIRM WHICH PREPARES THE AUDIT AND THEN IT IS REVIEWED BY THE CFO AND CEO. IN ADDITION, A COPY OF THE RETURN IS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW BEFORE IT IS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION'S OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REMINDED OF THE CONFLICT OF INTEREST POLICY AND MUST SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. WHEN A CONFLICT OF INTEREST EXISTS, THE INTERESTED TRUSTEE MAY BE PRESENT FOR DISCUSSION TO ANSWER QUESTIONS, BUT MAY NOT ADVOCATE FOR THE ACTION TO BE TAKEN AND MAY BE ASKED TO LEAVE THE ROOM WHILE A VOTE IS TAKEN. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION FOR THE CEO IS SET BY THE BOARD OF DIRECTORS AND IS DOCUMENTED IN THE BOARD MINUTES AND CEO'S WRITTEN CONTRACT. TO SET THE CEO'S COMPENSATION, RLMC USES TWO EXTERNAL REPORTS FOR DETERMINING AND SETTING SALARY RANGES. THESE INCLUDE THE MINNESOTA HOSPITAL ASSOCIATION SALARY SURVEY REPORT, THE "HHRAM" (HEALTHCARE HUMAN RESOURCES ASSOCIATION OF MINNESOTA) SALARY SURVEY BOOK, AND THE MEDICAL GROUP MANAGEMENT ASSOCIATE (MGMA) PHYSICIAN COMPENSATION REPORT SURVEY. THE COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES IS REVIEWED AND APPROVED BY THE CEO. HHRAM SALARY SURVEY IS USED IN DETERMINING THESE SALARIES AS WELL AS LONGEVITY AND PERFORMANCE EVALUATIONS. THESE DECISIONS ARE DOCUMENTED IN THE EMPLOYEE'S PERSONNEL FILE. ALL REVIEWS ARE PERFORMED AT LEAST ANNUALLY. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE NOT OPEN TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 2,266,378. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,266,378. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 259,217. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 259,217. ANESTHESIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 503,104. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 503,104. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 491,951. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 491,951. DIETARY SERVICES: PROGRAM SERVICE EXPENSES 132,943. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 132,943. OTHER SERVICES: PROGRAM SERVICE EXPENSES 576,363. MANAGEMENT AND GENERAL EXPENSES 533,355. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,109,718. |
| FORM 990, PART XI, LINE 9: | CHANGE IN UNRECOGNIZED PENSION COSTS -322,453. OTHER ADJUSTMENT 4,342. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FALLS MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 HIGHWAY 71 | AddressLine1Txt |
| City | INTERNATIONAL FALLS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56649 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 204585807 | EIN |
| Primary Activities | SUPPORT | PrimaryActivitiesTxt |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12A, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSOCATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Comments