ST ALOISIUS HOSPITAL INC: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- ST ALOISIUS HOSPITAL INC (EIN 45-0226729)
- Tax period
- 2018-10-01 to 2019-09-30
- Filed
- 2020-05-26
- IRS object ID
- 202021479349300117
- Schema version
- 2018v3.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-05-26T11:58:54-05:00 | ReturnTs |
| Tax Period End | 2019-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Nicollet Mall Ste 1300 | AddressLine1Txt |
| City | Minneapolis | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554027033 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450226729 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Aloisius Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STAL | BusinessNameControlTxt |
| Phone | 7013244651 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 325 Brewster Street East | AddressLine1Txt |
| City | Harvey | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58341 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Michael Zwicker | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7013244651 | PhoneNum |
| Signature | 2020-05-20 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kim Hunwardsen CPA | PreparerPersonNm |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | PhoneNum |
| Preparation | 2020-05-20 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 216.147.181.47 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-05-20 | IPDt |
| IP Tm | 09:28:13 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 9EB6867304309B5BA7CF1F8994B8B429DCF961D0 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 9EB6867304309B5BA7CF1F8994B8B429DCF961D0 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-09-23 17:36:50Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Aloisius Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Michael Zwicker | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 325 Brewster Street East | AddressLine1Txt |
| City | Harvey | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58341 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $18,348,471 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.staloisius.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1938 | FormationYr |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Activity Or Mission | Provide healthcare and healing services with special concern for the elderly and poor | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 296 | TotalEmployeeCnt |
| Total Volunteers | 33 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $49,616 | PYContributionsGrantsAmt |
| CY Contributions Grants | $52,923 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $15,298,837 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $18,098,405 | CYProgramServiceRevenueAmt |
| PY Investment Income | $138,242 | PYInvestmentIncomeAmt |
| CY Investment Income | $170,943 | CYInvestmentIncomeAmt |
| PY Other Revenue | $125,625 | PYOtherRevenueAmt |
| CY Other Revenue | $26,200 | CYOtherRevenueAmt |
| PY Total Revenue | $15,612,320 | PYTotalRevenueAmt |
| CY Total Revenue | $18,348,471 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,329,211 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,616,095 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,468,823 | PYOtherExpensesAmt |
| CY Other Expenses | $7,168,565 | CYOtherExpensesAmt |
| PY Total Expenses | $15,798,034 | PYTotalExpensesAmt |
| CY Total Expenses | $17,784,660 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$185,714 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $563,811 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $17,511,498 | TotalAssetsBOYAmt |
| Total Assets EOY | $18,365,004 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,424,919 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,625,971 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,086,579 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,739,033 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | St. Aloisius Medical Center, inspired by Jesus, in union with the Sisters of Mary of the Presentation, ministers health to all we serve. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $15,394,575 | ExpenseAmt |
| Revenue | $18,098,405 | RevenueAmt |
| Desc | CRITICAL ACCESS HOSPITAL DESIGNATIONSt. Aloisius is a 25-bed acute care hospital and 85-bed nursing facility located in Harvey, North Dakota. The Hospital was designated as a Critical Access Hospital in 2002. As a critical access hospital, our role is vital to the health and welfare of the community we serve. The patient and resident days for FY 2019 were as follows: 656 acute days, 1,185 swing-bed days, and 24,148 nursing home days. RESPONDING TO THE NEEDS OF THE POORThe Community Liason has continued assisting with the volunteer programs such as Hospice and Long Term Care. (Continued on Schedule O) The Medical Center provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the Medical Center does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The estimated costs of the charges foregone, based upon an overall cost-to-charge ratio calculation, for the years ended September 30, 2019 was $4,000.In addition, the Medical Center provides services to other medically indigent patients under certain government-reimbursed public aid programs. Such programs pay providers amounts which are less than established charges for the services provided to the recipients, and for some services the payments are less than the cost of rendering the services provided. The Medical Center also commits significant time and resources to endeavors and critical services which meet otherwise unfulfilled community needs. Many of these activities are sponsored with the knowledge that they will not be self-supporting or financially viable.St. Aloisius provides a Senior Living Facility. This consists of 16 apartment units. Two of the one-bedroom apartments are handicap accessible. A noon meal is optional but is served 7 days per week. There is also a 24-hour emergency call system.St. Aloisius Long Term Care is an 85-bed skilled nursing facility licensed by the State of North Dakota. The facility provides occupational, physical and speech therapy and other activities offered 7 days per week. | Desc |
| Total Program Service Expenses | $15,394,575 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 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 | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 36 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 296 | 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 | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | 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 | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sandra Teubner | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7013244651 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 325 Brewster Street East | AddressLine1Txt |
| City | Harvey | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58341 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Daniel Stutlien | ||||||||
| Chair | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Susan Shearer | ||||||||
| Vice Chair | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Sr Elizabeth Rose Muscha | ||||||||
| Director (Until Sept) | 0.50 | 1.30 | Yes (X) | $0 | $0 | $0 | ||
| Sr Marlyss Dionne | ||||||||
| Director | 0.50 | 1.30 | Yes (X) | $0 | $0 | $0 | ||
| Chad Ziegler | ||||||||
| Director | 0.50 | 1.30 | Yes (X) | $0 | $0 | $0 | ||
| Jason Schneider | ||||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Gordon Schmidt | ||||||||
| Director | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Sr Debra Berry | ||||||||
| Director (as of Sept) | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Sr Elaine Lange | ||||||||
| Secretary non-voting | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Michael Zwicker | ||||||||
| President/CEO | 40.00 | 0.00 | Yes (X) | $0 | $231,191 | $41,632 | ||
| Sandra Teubner | ||||||||
| CFO | 40.00 | 0.00 | Yes (X) | $0 | $152,563 | $33,097 | ||
| Kimberly Thorson | ||||||||
| Nurse Practitioner | 40.00 | 0.00 | $185,272 | $0 | $5,558 | Yes (X) | ||
| Toni Bromley | ||||||||
| Pharmacist | 40.00 | 0.00 | $112,664 | $0 | $3,380 | Yes (X) | ||
| Rick Geier | ||||||||
| Physician | 40.00 | 0.00 | $116,354 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $414,290 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $383,754 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $83,667 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | 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 |
|---|---|---|---|---|---|
| Sisters of Mary of the Presentation Heal | |||||
| 1202 Page Drive SW PO BOX 10007 | Fargo | ND | 581060007 | Administrative Fees | $794,316 |
| Dakota Travel Nurses | |||||
| 1200 Collins Ave | Mandan | ND | 58554 | Contracted nursing | $334,638 |
| CPSI | |||||
| PO Box 850309 | Mobile | AL | 366850309 | Maintenance/contract services | $280,156 |
| CDFP PC | |||||
| 922 Lincoln Ave | Harvey | ND | 58341 | ER physician services | $189,800 |
| Homestead Recruiters | |||||
| 821 Senior Ave | Dickinson | ND | 58601 | ER provider coverage | $151,918 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $26,249 | GovernmentGrantsAmt |
| All Other Contributions | $26,674 | AllOtherContributionsAmt |
| Total Contributions | $52,923 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 622110 | $17,733,836 | $17,733,836 |
| Senior living | 623990 | $105,675 | $105,675 |
| Daycare services | 624410 | $54,149 | $54,149 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $204,745 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $204,745 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $18,098,405 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $170,943 | TotalRevenueColumnAmt |
| Exclusion | $170,943 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $26,200 | 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 | $26,200 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,200 | TotalRevenueColumnAmt |
| Exclusion | $26,200 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,348,471 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $18,098,405 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $197,143 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,431,021 | TotalAmt |
| Program Services | $7,624,489 | ProgramServicesAmt |
| Management And General | $806,532 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $196,501 | TotalAmt |
| Program Services | $177,703 | ProgramServicesAmt |
| Management And General | $18,798 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,397,325 | TotalAmt |
| Program Services | $1,263,653 | ProgramServicesAmt |
| Management And General | $133,672 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $591,248 | TotalAmt |
| Program Services | $533,935 | ProgramServicesAmt |
| Management And General | $57,313 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,125 | TotalAmt |
| Management And General | $60,125 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,367,631 | TotalAmt |
| Program Services | $1,425,048 | ProgramServicesAmt |
| Management And General | $942,583 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,594 | TotalAmt |
| Management And General | $29,594 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $477,530 | TotalAmt |
| Program Services | $342,408 | ProgramServicesAmt |
| Management And General | $135,122 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $428,453 | TotalAmt |
| Program Services | $427,199 | ProgramServicesAmt |
| Management And General | $1,254 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,793 | TotalAmt |
| Program Services | $48,946 | ProgramServicesAmt |
| Management And General | $42,847 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,364 | TotalAmt |
| Program Services | $9,364 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $405,752 | TotalAmt |
| Program Services | $384,433 | ProgramServicesAmt |
| Management And General | $21,319 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,093,489 | TotalAmt |
| Program Services | $1,036,035 | ProgramServicesAmt |
| Management And General | $57,454 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,755 | TotalAmt |
| Program Services | $81,755 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical supplies | $744,061 | $744,061 | |
| Repairs and maintenance | $492,397 | $412,872 | $79,525 |
| Bad debt expense | $486,241 | $486,241 | |
| Dietary food | $352,138 | $352,138 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,242 | TotalAmt |
| Program Services | $44,295 | ProgramServicesAmt |
| Management And General | $3,947 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,784,660 | TotalAmt |
| Program Services | $15,394,575 | ProgramServicesAmt |
| Management And General | $2,390,085 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $918,787 | BOYAmt |
| EOY | $1,078,687 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,800,163 | BOYAmt |
| EOY | $2,238,805 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $152,457 | BOYAmt |
| EOY | $159,861 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $131,742 | BOYAmt |
| EOY | $148,558 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $22,568,818 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $14,296,240 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,680,079 | BOYAmt |
| EOY | $8,272,578 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,820,324 | BOYAmt |
| EOY | $6,456,033 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,946 | BOYAmt |
| EOY | $10,482 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,511,498 | BOYAmt |
| EOY | $18,365,004 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,107,219 | BOYAmt |
| EOY | $1,267,890 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,335 | BOYAmt |
| EOY | $1,106 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,946 | BOYAmt |
| EOY | $10,482 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,299,419 | BOYAmt |
| EOY | $7,199,493 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,000 | BOYAmt |
| EOY | $147,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,424,919 | BOYAmt |
| EOY | $8,625,971 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,004,619 | BOYAmt |
| EOY | $9,667,992 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $81,960 | BOYAmt |
| EOY | $71,041 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,086,579 | BOYAmt |
| EOY | $9,739,033 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,511,498 | BOYAmt |
| EOY | $18,365,004 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $563,811 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $106,681 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$18,038 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| 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 D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $102,501 | OtherCostOrOtherBasisAmt |
| Book Value | $102,501 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,488,118 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,522,099 | DepreciationAmt |
| Book Value | $6,966,019 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,671,188 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,513,427 | DepreciationAmt |
| Book Value | $1,157,761 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $307,011 | OtherCostOrOtherBasisAmt |
| Depreciation | $260,714 | DepreciationAmt |
| Book Value | $46,297 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,272,578 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | SMPHS pooled investment funds | Desc |
| Book Value | $6,456,033 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $6,456,033 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated third-party payor settlements | Desc |
| Amt | $147,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $147,000 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $17,970,211 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $106,681 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$484,941 | OtherRevenueAmt |
| Revenue Not Reported | -$378,260 | RevenueNotReportedAmt |
| Revenue Subtotal | $18,348,471 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $18,348,471 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $17,298,419 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $17,298,419 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $486,241 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $486,241 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $17,784,660 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 2b: | The Medical Center hold funds under an agency relationship for the residents of the nursing facility. Funds held as of September 30, 2019 totaled $10,482. |
| Part X, Line 2: | The Medical Center is organized as a North Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Medical Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Medical Center is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose, if applicable. The Medical Center has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Medical Center believes that it has appropriate support for any tax position taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Medical Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 175.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | $4,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $244,172 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $197,984 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $46,188 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00270 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $248,172 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $197,984 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $50,188 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 28 | ActivitiesOrProgramsCnt |
| Persons Served | 3328 | PersonsServedCnt |
| Total Community Benefit Expns | $464,828 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $41,030 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $423,798 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02450 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,086,134 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $952,831 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $133,303 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00770 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 93 | ActivitiesOrProgramsCnt |
| Persons Served | 757 | PersonsServedCnt |
| Total Community Benefit Expns | $11,682 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $330 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,352 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 121 | ActivitiesOrProgramsCnt |
| Persons Served | 4085 | PersonsServedCnt |
| Total Community Benefit Expns | $1,562,644 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $994,191 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $568,453 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03290 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 121 | ActivitiesOrProgramsCnt |
| Persons Served | 4085 | PersonsServedCnt |
| Total Community Benefit Expns | $1,810,816 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,192,175 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $618,641 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03580 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 152 | PersonsServedCnt |
| Total Community Benefit Expns | $21,101 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $175 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $20,926 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 152 | PersonsServedCnt |
| Total Community Benefit Expns | $21,101 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $175 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $20,926 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $486,241 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $55,918 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $4,333,788 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,413,355 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$79,567 | 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 | St Aloisius Medical Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 325 Brewster Street East | AddressLine1Txt |
| City | Harvey | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58341 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.staloisius.com | WebsiteAddressTxt |
| State License | 5023a | 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 |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Aloisius Hospital | 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 | 18 | 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 Part V, Page 8 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.staloisius.com/resources-policies.html | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 175.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.staloisius.com/resources-policies.html | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.staloisius.com/resources-policies.html | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.staloisius.com/resources-policies.html | 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 Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| St. Aloisius Hospital | Part V, Section B, Line 5: The CHNA addressed the broad interest of the community by identifying a committee that then identified individuals that met recommended criteria and 15 interviews were conducted by UND Rural Health Team. The committee working with the UND Rural Health team consisted of members from the local economic development office, City of Harvey, Ministerial Association, Wells County Social Services, Wells County District Health as well as business and community members. The time period that the CHNA was completed was May 1- through June-30. There was a community meeting with invitations for additional input provided by community members identified to expand the population diversity. Electronic surveys cards were distributed, and 87 surveys were completed in addition to community meetings and individual interviews.The focus group included members from the City of Harvey, the Economic Development Board in Harvey, Public Health, Wells County Social Services and many business and community members. |
| St. Aloisius Hospital | Part V, Section B, Line 6b: A Community Health Needs Assessment was performed in the summer of 2019 in collaboration with Wells County District Health to determine the most pressing health needs of Harvey area. |
| St. Aloisius Hospital | Part V, Section B, Line 11: A Community Health Needs Assessment ("CHNA") was performed in Summer 2019 in collaboration with Wells County District Health to determine the most pressing health needs of Harvey area. The following needs will be addressed over the next 3 years. Implementation of the needs was not started in the fiscal year due to the timing of when the CHNA was completed.1. Increase the access of mental health and addiction providers within our service area.2. Develop a resilient community and environmental health care approach for the community at large.Mental HealthImplementation of the Community Mental Health services to include counselors for adult mental health and addiction needs.The goals: 1. Phase 1: Both agencies will collaborate on a regular basis with Rural Mental Health (RMHC) FNP-Psych and Village Family services MLSW to increase awareness of services and the full plan for our community's Mental Health and addiction needs.2. Mental Health providers will meet with St. Aloisius Medical Center staff at a minimum of 2 times in the next year.Increase the number of practicing Mental Health primary care providers over a three-year period. (FY19-FY21). The goals: 1. Sustainable program with RMHC is being addressed by RMHC board of directors. St. Aloisius Medical Center currently does not employ Mental Health practitioner but is a board member on RMHC board of directors. St. Aloisius Medical Center is reviewing Telemedicine-Mental Health services.2. The Harvey area Community Cares Coalition has existed for the past 6 years and has developed a strong collaboration with Harvey Public school, City of Harvey, faith communities, St. Aloisius Medical Center, Wells County District Health Unit, Village Family Services, Harvey business, community members, Harvey Police and WC sheriff office. This group will continue to lead the Mental Health concerns of our communities.3. The area Interagency committee meets monthly and will be informed of Mental Health services and plans as developed. Members include the Central Prairie Social Services, HAV-IT, City of Harvey, WCDHU, St. Aloisius, SAAF, Positive Progressions therapy, Options, Harvey Chamber, Alzheimer's Association, RMHC.Community and Environmental Health Attracting and retaining young familiesCreating community Health programStrengthen relationship between school, health services and community leadersKey Objectives: 1. JDA/ City of Harvey and WCDHU with St. Aloisius Medical Center will coordinate on job openings in the community.2. Community Health will be addressed with Governor Burgum's Main Street Initiative that City of Harvey has been nominated to partake in.Implementation Strategies: St Aloisius Medical Center has been developing a Director of Human Resource's position.The goals: Hire a Human Resource Employee. This employee will coordinate with JDA/City of Harvey to coordinate open job positions at St. Aloisius in conjunction with other community workforce openingsScrubs Camp will be developed with Bismarck State College educator. Scrubs Camp curriculum to be provided to area upper elementary students.The Hospital will not address the following health needs identified in the CHNA as part of this Implementation Plan due to limited resources and the need to allocate significant resources to the two priority health needs identified above. Senior population Health concerns1. Cost of long-term care and nursing homesRates are set by the cost report, but St. Aloisius utilizes group purchasing contracts to keep supply costs competitive. 2. Availability of services to assist elderly to remain in their homeSenior Housing apartments are available for tenants to hire their own caregivers in a handicap apartment setting with one meal offered per day.Ensure a safe environment and address the effects of violent crimeBoth the City of Harvey and Wells County Sheriff's Departments have added positions to their departments.Threat concerns:1. Illegal drug useAddressed by the local community police and Wells County Sheriff.2. Child AbuseCommunity Health and Central Prairie Social Services are resources that will address the need. 3. Healthy eating education and health food choices Classes are conducted by Wells County District Health4. Youth alcohol use is being addressed through a grant to the Wells County District Health Unit. |
| St. Aloisius Hospital | Part V, Section B, Line 16j: A note is printed on monthly statements providing information regarding financial assistance. The financial assistance policy is provided to self-pay patients upon registration at the Hospital. It is not provided to all patients. The Uncompensated Care & Service Application and information regarding the financial assistance policy is available on our website and available upon request. |
| Part V, Section B, Line 7a, CHNA website: | www.staloisius.com/resources-policies.html |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - St Aloisius Long Term Care | ||||
| 325 Brewster Street East | Harvey | ND | 58341 | Skilled nursing facility |
| 2 - St Aloisius Senior Housing | ||||
| 325 Brewster Street East | Harvey | ND | 58341 | Senior housing units |
| 3 - St Aloisius Medical Center Clinic | ||||
| 317 Brewster Street East | Harvey | ND | 58341 | Clinic |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 6a: | The Organization's community benefit report can be found on its website at www.staloisius.com. |
| Part I, Line 7: | Charity care expense was converted to cost on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid was calculated using the costing methods to prepare the cost reports. Community health improvement services and cash and in-kind contributions are reported based on actual expenses recorded in the Organization's general ledger. The cost for subsidized health services reported on line 7g was determined using the Medicare cost report. |
| Part I, Ln 7 Col(f): | The amount of bad debt expense removed from total expenses to determine the percentage was $486,241. |
| Part II, Community Building Activities: | Our staff participated in community civic groups, boards and committees such as Kiwanis, Knights of Columbus, school board, Harvey Community Library Board, Relay for Life and Community Cares. |
| Part III, Line 2: | Before an account is written off to bad debt all discounts and payments are applied, including contractual allowances and discounts. Payments on accounts that were written off as bad debt reduces bad debt expense. Bad debt expense on line 2 is reported at charges as presented on the financial statements. |
| Part III, Line 3: | The estimated amount of the Organization's bad debt expense attributable to patients eligible under the organization's charity care policy is based on 11.5% of individuals living below the federal poverty level. The amount on line 3 is an estimate amount that could reasonably be attributable to patients who likely would have qualified for financial assistance under the charity care program if sufficient information had been obtained to make a determination of their eligibility. |
| Part III, Line 4: | The footnote to the Organization's financial statements can be found on page 9 of the attached audited financial statements. |
| Part III, Line 8: | St. Aloisius Hospital provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the Medicare shortfall is considered a community benefit.Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. |
| Part III, Line 9b: | Patients that are in the process of applying for charity care or have been approved for charity care will not have collection procedures brought on them. If a patient does not complete the Caring Program application within 120 days the account will follow the same collection procedure as other accounts. Accounts turned over to collections may be eligible for the Caring Program if the patient completes an application and is approved within an additional 120 days. After a determination of charity care, any personal portion due would follow the same collection procedures as other patients. Persons that have been granted bankruptcy by the courts are transferred to the Caring Program and written off as charity care. No collection procedures are pursued. |
| Part VI, Line 2: | St. Aloisius addresses needs throughout the community in addition to completing the CHNA. The Hospital employs a marketing/public relations individual that is active with the local schools and provides feedback on needs in the community. A community care program, named "Community Cares Coalition" was formed to address and assist with suicide prevention. The Hospital has other activities to assist families in need throughout the community. |
| Part VI, Line 3: | St. Aloisius has a Revenue Cycle Manager, RCM, who works in conjunction with the business office staff on reviewing patient accounts both with insurance and those who are self-pay. Our monthly billing statements include information regarding financial assistance. The financial assistance policy is provided to self-pay patients upon registration at the Hospital and Clinic. It is not provided to all patients. The application for Uncompensated Care and Services and information regarding the financial assistance policy is available on our website and available upon request.The hospital nurses ask the patient if they have any financial concerns about their hospital stay and if they do, the nurse calls the RCM or CFO to notify them that the patient has financial questions. The RCM or CFO will then follow up with the patient about their concerns. |
| Part VI, Line 4: | St. Aloisius Medical Center is a non-profit Critical Access Hospital located in central North Dakota. We serve more than 15 rural communities including Harvey where we are located. Our area of service is approximately 90 miles in diameter. Local doctors have clinics in Harvey, Fessenden (17 miles away) and Drake (23 miles away). In 2019, 32% of adults in Wells County were considered obese compared to 32% in North Dakota and 26% nationally. This is a decrease from 2017 of 33.2% in North Dakota. Adult smokers by percent of population in Wells County is 14% compared to 20% in North Dakota and 14% in the US. Excessive drinking was 20% in Wells County, 26% in North Dakota and 13% in the US. Injury Deaths were more prevalent in Wells County (77 deaths per 100,000 residents) than in the state overall (69 per 100,000 residents) and the top 10% of US Counties (57 per 100,000 residents). In Wells County, 50% of households have one or more seniors (60 and older). Unemployment in North Dakota in 2018 was 2.6%. The estimated median household income in Wells County for 2018 was $58,261. The estimated median household income was $61,843. Also, 11.5% of residents had income below the poverty level.Services offered include acute care, swing bed, surgery, clinic, senior housing and long-term care services. Our average acute/swing bed daily census is 5.8 patients. Our average clinic visits per month in FY19 was 574. Long term care average daily census was 72.4. St. Aloisius Medical Center has provided services in Harvey since 1938 with the Sisters of Mary of the Presentation Health System. With a special mission to serve the poor, the Sisters' have offered healing hospitality to all who come to us for care.The closest critical access hospitals are Heart of America Medical Center located in Rugby, ND approximately 42 miles away and Carrington Health Center located in Carrington, ND approximately 54 miles away. |
| Part VI, Line 5: | The Organization's governing body is composed of representatives from Harvey and surrounding local communities in addition to representatives from the Sisters of Mary of the Presentation. The group is diverse, as it includes lay people, religious representatives and business men and women. This diversity represents the rural population we serve. Five Board Members are from the city of Harvey and the other two Board Members reside outside of Harvey.This facility extends medical staff privileges to those qualified practitioners based on an established credentialing process. We are not a research facility. Any excess funds are reinvested into funded depreciation for future capital projects for the facility. As a critical access facility, there have not been many years with excess funds, but when there is, the facility has made improvements in building infrastructure to increase quality and efficiency for our patients and residents we serve. We have hired additional staff in our therapy department and sent them to educational training to expand service offerings to patients such as dry needling this past year and lymphedema treatments in FY20. We are also currently training a radiology technologist into Ultrasound so that we will employ our own ultrasound technician rather than paying a contract vendor.St. Aloisius Medical Center is very supportive of community organizations. The following are examples of services St. Aloisius has provided to the community at large for a total of $456,076.1. The facility has a 24/7 emergency room available to patients regardless of ability to pay.2. Sponsored weekly radio spots where health issues are addressed3. 24/7 Pastoral Care services.4. Provided our exercise/fitness area for the community in our cardiac rehab center. This year there were 213 people who used the wellness center visits for 2,069 encounters.5. Provided lab services to 940 patients during our spring and fall Wellness Days.6. Provided Natural Family Planning services to the community with four couples participating this past year.7. Our Diabetic Educator hosted DEEP classes on diabetic education with 15 participants as well as counseled 39 acute and swing bed patients.8. With our new Cardiac Ready Community Project, we conducted blood pressure screenings for 1,378 patients, where six were referred to their providers for further follow up. We also trained 407 community members on hands only CPR.9. We provided sports physicals to 49 area athletes and their payments for the physicals of $980 was donated to Wells County Booster club.10. Provided Suicide prevention education to the schools in the county and worked with the Community Cares on suicide prevention events.11. Provided donations to local school projects and other community groups, memorial services, child protection referrals.12. Presented bi-weekly "Did You Know" health information in the local newspaper. 13. Provided office space (in kind) for Hearing Aid Services and Rural Mental Health consortium staff/clients in our outpatient services building. There were 152 people served with 428 encounters by the Rural Mental Health staff.14. Provided cable television, internet and phone to our patients and residents which is non-reimbursable on our cost report.15. Provided the use of the Presentation Center for meetings/celebrations.16. Sent outdated supplies to local missionaries for distribution in the Philippines. |
| Part VI, Line 6: | We are an affiliate of the Sisters of Mary of the Presentation Health Corporation. St. Aloisius Medical Center operates in accordance with the mission, vision, and values of the Sisters of Mary of the Presentation Health Corporation. Our annual budgeting process includes an assessment of how our budget demonstrates a commitment to the values of the system and the system works to ensure we are always mindful of our duty to care for the poor and those in need. St. Aloisius Medical Center has a Strategic Plan developed from themes set forth by the health system for all affiliates. The strategic plan is an active document which St. Aloisius Medical Center works on continuously and reports back to the health system on our progress toward established goals which again, align with the mission, vision, and values of the organization. We met in December 2019 to establish a new three-year plan, as our previous plan was completed in less than three years (about 2 years). |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Michael Zwicker | ||||||||||||||
| President/CEO | $0 | $199,875 | $0 | $25,220 | $0 | $6,096 | $0 | $16,271 | $0 | $28,313 | $0 | $275,775 | $0 | $0 |
| Sandra Teubner | ||||||||||||||
| CFO | $0 | $137,085 | $0 | $13,060 | $0 | $2,418 | $0 | $7,735 | $0 | $27,283 | $0 | $187,581 | $0 | $0 |
| Kimberly Thorson | ||||||||||||||
| Nurse Practitioner | $185,272 | $0 | $0 | $0 | $0 | $0 | $5,558 | $0 | $330 | $0 | $191,160 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule J, Part I, Question 3: | FormAndLineReferenceDesc |
| Explanation | St. Aloisius Medical Center does not pay compensation to the CEO. This individual is compensated by Sisters of Mary of the Presentation Health System, a related organization, for services at the Hospital. Sisters of Mary of the Presentation Health System uses one or more of the methods on Part I, question 3 to determine compensation. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, line 2 | A Free Standing Physician clinic began operations 8/6/2018. |
| Form 990, Part VI, Section A, line 2 | Mark Zwicker and Sandra Teubner have a business relationship. |
| Form 990, Part VI, Section A, line 6 | The sole member of the Organization is the Sisters of Mary of the Presentation Health System. |
| Form 990, Part VI, Section A, line 7a | The member is entitled to vote in the election of Directors and to cast one vote for each Director to be elected. The member is also entitled to one vote on every other matter to be voted on by the member. Votes cast on behalf of the member are cast by the Chief Executive Officer of Sisters of Mary of the Presentation Health System. |
| Form 990, Part VI, Section A, line 7b | The authority to act on the following matters are exclusively vested in the member of the organization: 1. any change in the philosophy, objectives and purposes of the organization; 2. amendment of the articles of incorporation and bylaws; 3. the election or removal of the Directors; 4. merger or consolidation with any other organization; 5. dissolution of the organization or the sale, lease or exchange of all or substantially all of its property or assets; 6. the sale, lease, transfer or encumbrance of any land, buildings or other assets owned by the organization or in which the organization has or will have equitable or legal title; 7. approval of the annual operating and capital budgets; 8. appointment of the Chief Executive Officer. |
| Form 990, Part VI, Section A, line 8b | The Organization does not have committees with authority to act on behalf of the governing body. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is provided to the governing Board before it is filed. The Organization's CEO and CFO review the 990. |
| Form 990, Part VI, Section B, line 12c | Each Director must submit in writing to the Chairperson of the Board and the Chief Executive Officer a list of all business or other organizations of which the individual is an officer, director, trustee, member, owner (either as a sole proprietor or partner), shareholder with a 5% or greater interest in all outstanding voting shares, employee or agent, with which the organization has, or might reasonably in the future enter into, a relationship or a transaction in which the Director would have conflicting interests. Each written statement is resubmitted with any necessary changes each year. The Chairperson of the Board reviews the statements of the Directors and the Vice Chairperson of the Board reviews the statement filed by the Chairperson. When a conflict arises the affected Director makes known the potential conflict, whether disclosed by written statement or not, and after answering any questions, will withdraw from the meeting for as long as the matter continues under discussion. Should the matter be brought to a vote, the affected Director will not vote on it. In the event the Director does not withdraw voluntarily, the Chairperson of the Board has authority to require the Director to remove himself from the room during both the discussion and vote on the matter. In the event the conflict of interest affects the Chairperson, the Vice Chairperson has authority to require the Chairperson remove himself in the same matter. If the matter is the item of business for which a special meeting of the Board was called, the affected Director will not be counted to establish a quorum, and he will not participate in the deliberations or vote on it. |
| Form 990, Part VI, Section B, line 15 | The Organization's CEO and CFO are both compensated by Sisters of Mary of the Presentation Health System, a related organization. The compensation process is determined by the related organization. The Sisters of Mary of the Presentation Health System Board of Trustees directly engages a nationally recognized independent compensation consulting firm to review the total compensation arrangements of the officers and key employees. The Sisters of Mary of the Presentation Health System Board of Trustees approves all compensation based on comparable data and documents their decision in the meeting minutes. |
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents, conflict of interest policy, and financial statements are not available to the public. Financial information is available through the public disclosure copy of the 990. |
| Form 990, Part IX, line 11g | Purchased services: Program service expenses 1,038,968. Management and general expenses 58,905. Fundraising expenses 0. Total expenses 1,097,873. Professional fees: Program service expenses 386,080. Management and general expenses 883,678. Fundraising expenses 0. Total expenses 1,269,758. |
| Form 990, Part XI, line 9: | Equity transfer to related party -18,038. |
| Form 990, Part XII, Line 2C: | The governing Board of Sisters of Mary of the Presentation Health System assumes responsibility for oversight of the audit for St. Aloisius Hospital. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Sisters of Mary of the Presentation Health System | ||||||||||
| 1202 Page Drive SW | Fargo | ND | 58103 | 450359620 | Facilitates management and operations of ten related facilities | ND | 501(c)(3) | Line 12b, II | SMP Health Ministry | 0 |
| Presentation Medical Center | ||||||||||
| 213 2nd Avenue NE | Rolla | ND | 583670759 | 450227391 | Provision of health care services | ND | 501(c)(3) | Line 3 | SMP Health System | 0 |
| St Margaret's Hospital | ||||||||||
| 600 East First Street | Spring Valley | IL | 61362 | 362167884 | Provision of health care services | IL | 501(c)(3) | Line 3 | SMP Health System | 0 |
| St Andrew's Hospital | ||||||||||
| 316 Ohmer Street | Bottineau | ND | 58318 | 450226426 | Provision of health care services | ND | 501(c)(3) | Line 3 | SMP Health System | 0 |
| Sisters of Mary of the Presentation Long Term Care | ||||||||||
| 1202 Page Drive SW | Fargo | ND | 581060007 | 752999939 | Provide extended care and medically related services | ND | 501(c)(3) | Line 11 | SMP Health System | 0 |
| St Andrew's Hospital Foundation | ||||||||||
| 316 Ohmer Street | Bottineau | ND | 58318 | 450413201 | Assist St. Andrew's Hospital in fund raising and fund management | ND | 501(c)(3) | Line 12b, II | SMP Health System | 0 |
| Prairieland Home Care | ||||||||||
| 1102 Page Drive SW | Fargo | ND | 581060007 | 450391192 | Home health and supportive services | ND | 501(c)(3) | Line 11 | SMP Health System | 0 |
| St Margaret's Hospital Foundation | ||||||||||
| 600 East First Street | Spring Valley | IL | 61362 | 364042262 | Provide support to St. Margaret's Hospital | IL | 501(c)(3) | Line 12b, II | SMP Health System | 0 |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| St Andrew's Bottineau Clinic LLC | |||||||
| 316 Ohmer Street | Bottineau | ND | 58318 | 450451306 | Provision of health care services | ND | N/A |
| Valley Regional Health Services L3C | |||||||
| 4391 Venture Drive | Peru | IL | 613541014 | 273891281 | Outpatient oncology services | IL | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| SMP Enterprises | |||||||||
| PO Box 10007 | Fargo | ND | 581060007 | 363486506 | Collection Agency | ND | N/A | C | 0 |
| SMP Enterprises - IL | |||||||||
| 600 East 1st Street | Spring Valley | IL | 61362 | 363456566 | Healthcare Management | IL | N/A | C | 0 |
| 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 | 0 | 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 | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |