ST ANDREWS HOSPITAL: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- ST ANDREWS HOSPITAL (EIN 45-0226426)
- Tax period
- 2018-10-01 to 2019-09-30
- Filed
- 2020-06-30
- IRS object ID
- 202031829349300928
- 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 | 2020-06-30T11:17:22-05:00 | 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 | 450226426 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Andrew's Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STAN | BusinessNameControlTxt |
| Phone | 7012289300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 316 Ohmer Street | AddressLine1Txt |
| City | Bottineau | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58318 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Alfred Sams | PersonNm |
| Person Title | President/CEO | PersonTitleTxt |
| Phone | 7012289300 | PhoneNum |
| Signature | 2020-06-01 | 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 | 2020-06-01 | 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 | 2020-06-01 | IPDt |
| IP Tm | 08:58:29 | 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 Andrew's Health Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Alfred Sams | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 316 Ohmer Street | AddressLine1Txt |
| City | Bottineau | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58318 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $10,957,771 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.standrewshealth.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1913 | FormationYr |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Activity Or Mission | Acute care critical access hospital | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 162 | TotalEmployeeCnt |
| Total Volunteers | 75 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $73,094 | PYContributionsGrantsAmt |
| CY Contributions Grants | $349,334 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,870,338 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,544,209 | CYProgramServiceRevenueAmt |
| PY Investment Income | $37,717 | PYInvestmentIncomeAmt |
| CY Investment Income | $44,691 | CYInvestmentIncomeAmt |
| PY Other Revenue | $20,715 | PYOtherRevenueAmt |
| CY Other Revenue | $19,537 | CYOtherRevenueAmt |
| PY Total Revenue | $10,001,864 | PYTotalRevenueAmt |
| CY Total Revenue | $10,957,771 | 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 | $4,747,423 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,954,164 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,921,586 | PYOtherExpensesAmt |
| CY Other Expenses | $5,052,953 | CYOtherExpensesAmt |
| PY Total Expenses | $9,669,009 | PYTotalExpensesAmt |
| CY Total Expenses | $10,007,117 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $332,855 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $950,654 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,350,293 | TotalAssetsBOYAmt |
| Total Assets EOY | $8,734,568 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,625,711 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,013,233 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,724,582 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,721,335 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | St. Andrew's Health Center, in union with the Sisters of Mary of the Presentation, works for the glory of God by bringing the Word and Healing of Jesus Christ to all, with a special concern for the poor and elderly. Through the shared ministry with the laity, St. Andrew's Health Center participates in the health care mission in the work of healing which is the work of God. Our individual inspiration is Jesus and His Gospel message. Permeated with the Charism of the Sisters of Mary of the Presentation, we minister to one another and to all who come to us for care. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $8,469,999 | ExpenseAmt |
| Revenue | $10,544,209 | RevenueAmt |
| Desc | St. Andrew's Health Center has been a part of the community since 1913. Our mission is to provide services to all who come to us for care; this is something that we are very proud of. Our ability to better the lives of those most in need is the core of our beliefs and knowing that we can make a difference in the lives of those we serve. In addition, we believe that through our leadership and presence in the community that we have been and will continue to be an essential part of the healthcare delivery team.St. Andrew's Health Center is designated as a Critical Access Hospital and has had the designation since July 2001. There were 334 acute patient days and 6,221 swing-bed days. (Continued on Schedule O)The percent of occupancy was 71.8%.We continue to utilize "The Guide for Planning and Reporting Community Benefit" book that was prepared by the Catholic Health Care Association to help determine what qualifies as a community benefit. We attend a variety of educational opportunities throughout the year to provide direction in reporting on our benefits to the community.The Health 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 Health Center does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The estimated costs of the charges foregone, based upon an overall cost-to-charge ratio calculation, for the year ended September 30, 2019 was $45,000.The Health 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. | Desc |
| Total Program Service Expenses | $8,469,999 | 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 | Yes (1) | 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 19 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 162 | 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 | 8 | 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 | 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 | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Alfred Sams | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7012289300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 316 Ohmer Street | AddressLine1Txt |
| City | Bottineau | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58318 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 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 |
|---|---|---|---|---|---|---|---|---|
| Steven Gorder | ||||||||
| Chairperson | 0.30 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Melissa Block | ||||||||
| Vice Chair | 0.30 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Sr Marlyss Dionne | ||||||||
| Director | 0.30 | 1.50 | Yes (X) | $0 | $0 | $0 | ||
| Sr Dorothy Bunce | ||||||||
| Director | 0.30 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Jeremi Tweed | ||||||||
| Director | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Darin Bohl | ||||||||
| Director | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Dan Bullinger | ||||||||
| Director | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Jodi Atkinson | ||||||||
| President/CEO until Dec 2018 | 40.00 | 3.00 | Yes (X) | Yes (X) | $0 | $272,054 | $42,197 | |
| Alfred Sams - CFO until | ||||||||
| Dec 2018/Pres/CEO starting Jan 2019 | 40.00 | 2.00 | Yes (X) | Yes (X) | $0 | $117,116 | $30,984 | |
| Steve Lindemann | ||||||||
| CFO starting September 2018 | 40.00 | 2.00 | Yes (X) | $0 | $35,385 | $6,340 | ||
| Cory Miller MD | ||||||||
| Family Medicine Physician | 40.00 | 0.00 | $234,092 | $0 | $24,973 | Yes (X) | ||
| Jessica Skjolden MD | ||||||||
| Family Medicine Physician | 40.00 | 0.00 | $240,648 | $0 | $24,788 | Yes (X) | ||
| Robert Hamilton MD | ||||||||
| Family Medicine Physician | 40.00 | 0.00 | $235,939 | $0 | $25,166 | Yes (X) | ||
| Steve Arnold NP | ||||||||
| Nurse Practitioner | 40.00 | 0.00 | $146,884 | $0 | $21,146 | Yes (X) | ||
| Chassidy Sharp NP | ||||||||
| Nurse Practitioner | 40.00 | 0.00 | $141,658 | $0 | $21,014 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $999,221 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $424,555 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $196,608 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | 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 | |||||
| PO Box 10007 | Fargo | ND | 58106 | Mgmt fees, pastoral care and legal | $684,995 |
| CPSI | |||||
| PO Box 850309 | Mobile | AL | 36685 | Software maintenance | $245,615 |
| Guardian Healthcare | |||||
| PO Box 306098 | Nashville | TN | 37230 | Travel Nursing Staff | $188,675 |
| DMS | |||||
| PO Box 670747 | Dallas | TX | 75267 | Nuclear medicine, ultrasound purchased s | $185,741 |
| DTN | |||||
| 1200 Collins Ave | Mandan | ND | 58554 | Travel Nursing Staff | $112,353 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $31,117 | RelatedOrganizationsAmt |
| Government Grants | $19,926 | GovernmentGrantsAmt |
| All Other Contributions | $298,291 | AllOtherContributionsAmt |
| Total Contributions | $349,334 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 622110 | $10,189,640 | $10,189,640 |
| Congregate housing/senior apartme | 623990 | $153,523 | $153,523 |
| Management fee | 900099 | $51,591 | $51,591 |
| Loss on Clinic investment | 900099 | -$51,000 | -$51,000 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $200,455 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $200,455 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,544,209 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $44,691 | TotalRevenueColumnAmt |
| Exclusion | $44,691 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $19,537 | 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 | $19,537 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,537 | TotalRevenueColumnAmt |
| Exclusion | $19,537 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,957,771 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,544,209 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $64,228 | 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 | $3,955,866 | TotalAmt |
| Program Services | $3,474,009 | ProgramServicesAmt |
| Management And General | $481,857 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,272 | TotalAmt |
| Program Services | $86,302 | ProgramServicesAmt |
| Management And General | $11,970 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $626,875 | TotalAmt |
| Program Services | $550,516 | ProgramServicesAmt |
| Management And General | $76,359 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $273,151 | TotalAmt |
| Program Services | $239,879 | ProgramServicesAmt |
| Management And General | $33,272 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,637 | TotalAmt |
| Management And General | $6,637 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,992 | TotalAmt |
| Management And General | $42,992 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,550,111 | TotalAmt |
| Program Services | $984,406 | ProgramServicesAmt |
| Management And General | $565,705 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,228 | TotalAmt |
| Management And General | $20,228 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $387,466 | TotalAmt |
| Program Services | $324,783 | ProgramServicesAmt |
| Management And General | $62,683 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $263,330 | TotalAmt |
| Program Services | $243,280 | ProgramServicesAmt |
| Management And General | $20,050 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,292 | TotalAmt |
| Program Services | $9,209 | ProgramServicesAmt |
| Management And General | $13,083 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,194 | TotalAmt |
| Management And General | $16,194 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,513 | TotalAmt |
| Program Services | $11,193 | ProgramServicesAmt |
| Management And General | $1,320 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $396,183 | TotalAmt |
| Program Services | $354,392 | ProgramServicesAmt |
| Management And General | $41,791 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,236 | TotalAmt |
| Program Services | $69,236 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical supplies | $1,507,728 | $1,507,728 | |
| Repairs and maintenance | $293,439 | $209,981 | $83,458 |
| Bad debt expense | $277,111 | $277,111 | |
| Food | $93,597 | $93,597 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,896 | TotalAmt |
| Program Services | $34,377 | ProgramServicesAmt |
| Management And General | $59,519 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,007,117 | TotalAmt |
| Program Services | $8,469,999 | ProgramServicesAmt |
| Management And General | $1,537,118 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $545,040 | BOYAmt |
| EOY | $1,338,178 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,591,660 | BOYAmt |
| EOY | $1,615,360 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $299,660 | BOYAmt |
| EOY | $279,745 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $125,671 | BOYAmt |
| EOY | $96,981 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $10,358,327 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,465,176 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,532,415 | BOYAmt |
| EOY | $2,893,151 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,428,322 | BOYAmt |
| EOY | $1,695,609 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,850 | BOYAmt |
| EOY | $7,850 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $819,675 | BOYAmt |
| EOY | $807,694 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,350,293 | BOYAmt |
| EOY | $8,734,568 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $780,833 | BOYAmt |
| EOY | $858,898 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,750 | BOYAmt |
| EOY | $4,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $842,128 | BOYAmt |
| EOY | $880,335 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $270,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,625,711 | BOYAmt |
| EOY | $2,013,233 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,960,371 | BOYAmt |
| EOY | $5,931,080 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $669,211 | BOYAmt |
| EOY | $695,255 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $95,000 | BOYAmt |
| EOY | $95,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,724,582 | BOYAmt |
| EOY | $6,721,335 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,350,293 | BOYAmt |
| EOY | $8,734,568 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $950,654 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $24,647 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $21,452 | 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 | 0 | 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 | $118,981 | OtherCostOrOtherBasisAmt |
| Book Value | $118,981 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,801,523 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,130,337 | DepreciationAmt |
| Book Value | $1,671,186 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,321,301 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,233,845 | DepreciationAmt |
| Book Value | $1,087,456 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $116,522 | OtherCostOrOtherBasisAmt |
| Depreciation | $100,994 | DepreciationAmt |
| Book Value | $15,528 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,893,151 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Pooled investment fund | Desc |
| Book Value | $1,695,609 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $1,695,609 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Other receivables | $17,939 |
| Interest in net assets of St. Andrew's Health Center | $789,755 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $807,694 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated third-party payor settlements | Desc |
| Amt | $270,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $270,000 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $10,705,307 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $24,647 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$277,111 | OtherRevenueAmt |
| Revenue Not Reported | -$252,464 | RevenueNotReportedAmt |
| Revenue Subtotal | $10,957,771 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $10,957,771 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $9,730,006 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $9,730,006 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $277,111 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $277,111 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $10,007,117 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 2b: | St. Andrew's Hospital acts as custodian for the patients and holds patient security deposits. |
| Part X, Line 2: | The Health 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 Health Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Health Center is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Health 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 Health Center believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Health 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. |
| Part XI, Line 2d - Other Adjustments: | Provision for bad debts recorded in revenue for financial statements -277,111. |
| Part XII, Line 4b - Other Adjustments: | Provision for bad debts recorded in revenue for financial statements 277,111. |
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 |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| 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 | $45,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $45,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00460 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $45,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $45,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00460 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $280,611 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $187,831 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $92,780 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00950 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $280,611 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $187,831 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $92,780 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00950 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $325,611 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $187,831 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $137,780 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01410 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $277,111 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $27,711 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $5,242,089 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,275,578 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$33,489 | 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 Andrew's Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 316 Ohmer Street | AddressLine1Txt |
| City | Bottineau | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58318 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.standrewshealth.com | WebsiteAddressTxt |
| State License | 5005 | 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 Andrew's 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 | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | https://www.standrewshealth.com/resources/ | 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 | https://www.standrewshealth.com/resources/ | 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 | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| 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 | https://www.standrewshealth.com/resources/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://www.standrewshealth.com/resources/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://www.standrewshealth.com/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 |
| 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 (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| St. Andrew's Hospital | Part V, Section B, Line 5: Meetings were held with a wide variety of community leaders including public health, business leaders, and other interested individuals. |
| St. Andrew's Hospital | Part V, Section B, Line 6a: Public Health |
| St. Andrew's Hospital | Part V, Section B, Line 11: A number of needs were identified in the 2018 CHNA process conducted by the UND Center for Rural Health. During the final community group meeting, public health and other community leaders identified the following needs:Identified Need: Availability of Behavioral HealthGoal: Increase Awareness of, and Access to, Behavioral ServicesObjective: Develop a Collaborative Approach to Behavioral Health AvailabilityIdentified Need: Availability of Resources to Help the Elderly Stay in Their HomesGoal: Gather resources available in our communities.Objective: Make available a document outlining available opportunities.Identified Need: Health and WellnessGoal: Increase Awareness of Health and Wellness OpportunitiesObjective: Become a better health and wellness educated communityIdentified Need: Adequate Childcare ServicesGoal: Increase community options for childcareObjective: Engage and work with community stakeholders to combine resources that will address and increase options for childcareThe Hospital will not address this need specifically, but plans on working with community groups to address the priority:Identified Need: Attract and Retain FamiliesGoal: Provide resources for new families to network within the community.Objective: Increase overall family community engagement.This CHNA was completed at the end of the fiscal year therefore no needs were addressed, but will be over the next 3 years. |
| St. Andrew's Hospital | Part V, Section B, Line 13h: Individuals with medical expenses in excess of 30% of their gross income who would otherwise not qualify for the Caring Program based on their earnings can qualify for catastrophic charity care and receive a reduction in the cost of their medical services. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - St Andrew's Senior Housing | ||||
| 316 Ohmer Street | Bottineau | ND | 58318 | Senior housing |
| 2 - St Andrew's Bottineau Clinic LLC | ||||
| 316 Ohmer Street | Bottineau | ND | 58318 | Family practice clinic |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | In addition to using 200% of the federal poverty guidelines to determine eligibility for providing discounted care to low income individuals, St. Andrew's Hospital also uses a sliding fee schedule based on income and family size. Depending on income and family size a patient could have 20%, 40%, 60%, 80% or 100% written off to charity care.Individuals with medical expenses in excess of 30% of their gross income who would otherwise not qualify for the Caring Program based on their earnings can qualify for catastrophic charity care and receive a reduction in the cost of their medical services.Part I, Line 6b:St. Andrew's Hospital makes its community benefit report available to the public by posting it on our website and an internal bulletin board. |
| Part I, Line 7: | Charity care expense was converted to cost based on an overall cost-to-charge ratio addressing all patient segments. Inpatient and outpatient Hospital services provided to Medicaid program beneficiaries are primarily paid on a cost-related basis, therefore there is no community benefit related to Medicaid on line 7b. Community health improvement services and health professions education are reported based on actual expenses recorded in the organization's general ledger. The cost for subsidized health services 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 $277,111. |
| Part III, Line 2: | All past due accounts are reviewed to determine if a patient qualifies for charity care, or federal, state, or local assistance. Before an account is written off to bad debt all discounts and payments are applied, including contractual allowances. After every attempt is made to collect the unpaid balance, the account is written off to bad debt. 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 10% of individuals living below the federal poverty level (per 2017 American Community Survey as shared in the 2019 CHNA conducted by UND Center for Rural Health). |
| Part III, Line 4: | The footnote to the Organization's financial statements can be found on page 10 of the attached audited financial statements. |
| Part III, Line 8: | St. Andrew's 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 Medicaid and Medicare Services. |
| Part III, Line 9b: | Individuals provided with charity discounts, financial assistance, or are on payment plans are not referred to a collection agency. After a determination of charity care, any personal portion due would follow the same collection procedures as other types of patients. If a patient does not complete the financial assistance application within 120 days presumptive charity care is reviewed and then the account will follow the same collection procedure as other accounts. Accounts turned over to collections may be eligible for the financial assistance if the patient completes an application and is approved within an additional 120 days. After a determination of financial assistance, any personal portion due would follow the same collection procedures as other patients. |
| Part VI, Line 2: | In addition to the CHNA, the Hospital receives regular feedback on community needs from board members, other community organizations such as Economic Development Corporation and Chamber of Commerce, and from interested community members. |
| Part VI, Line 3: | Extensive signage is posted throughout the facility in the ER, waiting rooms, and the admissions/registration area. Patient statements include language regarding opportunity for financial assistance. The financial assistance policy and application for charity care/financial assistance are on the website. All collection related notices include encouragement to patients to explore financial assistance. The facility employs a full-time employee, the Community Resource Coordinator (CRC), who offers an array of services in searching for medical/dental coverage for those that are underinsured or uninsured. The number of uninsured and underserved is growing in Bottineau County. We are seeing an increase in the individual's out of pocket costs that remain following payments provided by their insurance carriers. With the rise in health care premiums and aging population, families have to make some difficult decisions. The lack of insurance or underinsured has a devastating effect on the people of our community. We are committed to the Catholic Healthcare Initiative on working towards insurance coverage issues for the uninsured and underinsured. |
| Part VI, Line 4: | St. Andrew's Hospital is a 25-bed acute care hospital and a senior apartment facility located in Bottineau, North Dakota. St. Andrew's Hospital serves approximately 7,500 individuals, encompassing a large part of Bottineau County. Bottineau County is located in rural, North Central North Dakota, next to the Canadian border. Our main patient base is of senior-citizen age, as the percentage of individuals over the age of 65 in Bottineau County is 23.8%. 10% of our population base is living below the poverty level and the estimated median household income was $58,767. Unemployment was 2.3% compared to 2.3% in North Dakota. The most common industries are retail trade, health care and social assistance and construction. |
| Part VI, Line 5: | St. Andrew's Health Center's board is comprised of eight members: The CEO, two sisters from the Sisters of Mary of the Presentation, and five community members otherwise unaffiliated with the facility or Sisters of Mary of the Presentation. To meet the needs of our community, the Hospital extends privileges to medical staff that are qualified and licensed. In addition to regular planning for systematic replacement/enhancement of patient care equipment like CT scanners and patient beds, the organization periodically assesses additional needs for equipment and utilizes surplus funds as well as community donations to help meet those needs.St. Andrew's Hospital and its team of co-workers strive to increase their level of community involvement. Many of the employees of St. Andrew's Hospital serve on multiple local and regional committees working to improve the health and lives of the members of Bottineau County. St. Andrew's Hospital operates an emergency room available 24 hours a day and accepts all patients, regardless of ability to pay. We are the sole provider of emergency and inpatient services in our county. The Hospital operates a separate foundation which conducts fundraising activities and solicits funds that are utilized to further the programs of St. Andrew's Hospital. The Foundation makes regular contributions to the Hospital for items that directly improve patient care (minor and capital). We also work with the school system to provide volunteer opportunities for students to work in the Health Care Center.Beyond Charity CareIn addition to our free charity care, SAHC has provided many other services to meet the needs of those in Bottineau County and service area: we provide access to clinical practice to the Bottineau and Minot region.A number of students job shadow in various departments as part of their education requirements. Over the past year we have had students job shadowing or completing internship hours for Pharmacy technician and Nurse Practitioner (NP) programs. We also have the school of nursing students from Dakota College Bottineau at the facility completing practicals during the college school year. We are happy to be a clinical site to Dakota College-Bottineau for the ADN/PN nursing program and UND for the NP program; we have a number of students that utilize St. Andrews Health Center for their clinicals on a day to day basis. St. Andrew's Health Center allows for time to educate high school students about potential career opportunities in health care and provides job shadowing opportunities for those interested. We work closely with the Health and Sciences Instructor from the local high school to provide health career access to the students. We also participate in a Scrubs Camp program for junior high students. This was coordinated through St. Andrews Health Center and provides opportunities for students exploring health care options. We also participate in a number of other educational opportunities with students to generate a career in health care; EMT summer school, and 2nd grade tour, just to name a few. We have provided presentations to members of our community and the surrounding areas/groups to educate them about the health and wellness issues. We have a regular Healthbeat article that is printed in our local newspaper. We also have a weekly radio spot to discuss current healthcare related issues. We expanded our service offers to bring blood pressures and wellness profiles to the communities of Bottineau and Westhope. Office space and a liaison are provided to the Rural Mental Health Consortium so that we can continue to offer behavioral health services to the community on an outpatient basis. The demand for behavioral health services in the State of North Dakota has grown substantially. We are very pleased to offer this service at the local level and are working strategically to tie this into the identified needs of the CHNA. St. Andrews Health Center participates in a number of community events/activities that pertain to healthcare and our direct relations to our community; including wellness committee, bio terrorism group, disaster preparedness, co-sponsor a blood drive, blood pressures are offered during a variety of community events such as North Central Electric's annual meeting held in June, and our annual Hospital week celebration, just to name a few. We offer a free blood pressure screening day every Tuesday. This helps monitor the vascular health of 20 to 30 patients each week. Annually we impact about roughly 1000 people.St. Andrews Health Center provides conference rooms for local non-profit organizations for meeting use.Throughout the year we held food pantry drives and collected funds to give to the school system for children in need of money for milk at snack time. We also have an angel tree within the facility that has a range of ages of boys and girls that are in need of receiving some gifts at Christmas. We do this in collaboration with a service group in our community.We continue to maintain the Community Resource Coordinator (CRC); this person offers assistance to those in need. The CRC offers an array of services in searching for medical/dental coverage for those that are underinsured or uninsured. The CRC maintains our blanket hugs program and provided approximately 70 free blankets for pediatric patients in need of comforting. The CRS also helps individuals fill out Caring Program paperwork. In total the CRC provides resources to approximately 100 people in our community and service area; without the resource many of these individuals would have gone with needs unmet. |
| Part VI, Line 6: | We are an affiliate of the Sisters of Mary of the Presentation Health Corporation. St. Andrew's Hospital 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. Andrew's Hospital 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. Andrew's Hospital 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. |
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 (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jodi Atkinson | ||||||||||||||
| President/CEO until Dec 2018 | $0 | $190,262 | $0 | $23,689 | $0 | $58,103 | $0 | $14,018 | $0 | $31,008 | $0 | $317,080 | $0 | $0 |
| Cory Miller MD | ||||||||||||||
| Family Medicine Physician | $234,092 | $0 | $0 | $0 | $0 | $0 | $7,193 | $0 | $17,780 | $0 | $259,065 | $0 | $0 | $0 |
| Jessica Skjolden MD | ||||||||||||||
| Family Medicine Physician | $240,648 | $0 | $0 | $0 | $0 | $0 | $7,536 | $0 | $17,252 | $0 | $265,436 | $0 | $0 | $0 |
| Robert Hamilton MD | ||||||||||||||
| Family Medicine Physician | $235,939 | $0 | $0 | $0 | $0 | $0 | $7,386 | $0 | $17,780 | $0 | $261,105 | $0 | $0 | $0 |
| Steve Arnold NP | ||||||||||||||
| Nurse Practitioner | $146,884 | $0 | $0 | $0 | $0 | $0 | $4,735 | $0 | $16,411 | $0 | $168,030 | $0 | $0 | $0 |
| Chassidy Sharp NP | ||||||||||||||
| Nurse Practitioner | $141,658 | $0 | $0 | $0 | $0 | $0 | $4,603 | $0 | $16,411 | $0 | $162,672 | $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. Andrew's Hospital does not pay compensation to the President/CEO. This position is compensated by Sisters of Mary of the Presentation Health System, a related organization, for services to the Hospital. Sisters of Mary of the Presentation Health System uses one or more of the methods in Part I, question 3 to determine compensation. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. The member has the exclusive right to elect or remove Directors. |
| 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 made available to the governing body before it is filed. The Organization's President/CEO and CFO review the Form 990. |
| Form 990, Part VI, Section B, line 12c | Each Director and Officer 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 manner. 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 President/CEO and CFO are compensated by Sisters of Mary of the Presentation Health System. The compensation process is determined by Sisters of Mary of the Presentation Health Corporation. 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 984,406. Management and general expenses 59,173. Fundraising expenses 0. Total expenses 1,043,579. Administrative services: Program service expenses 0. Management and general expenses 506,532. Fundraising expenses 0. Total expenses 506,532. |
| Form 990, Part XI, line 9: | Equity transfer to Sisters of Mary of the Presentation Health Corporation -10,592. Change in interest in net assets of St. Andrew's Health Center Foundation 32,044. |
| 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. Andrew's 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 Dr SW | Fargo | ND | 58103 | 450359620 | Facilitate management and operations of ten related facilities | ND | 501(c)(3) | Line 12a, I | SMP Health Ministry | 0 |
| St Andrew's Hospital Foundation | ||||||||||
| 316 Ohmer Street | Bottineau | ND | 58318 | 450413201 | Provide support to St. Andrew's Hospital | ND | 501(c)(3) | Line 12a, I | 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 10 | SMP Health System | 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 Aloisius Hospital | ||||||||||
| 325 East Brewster Street | Harvey | ND | 58341 | 450226729 | 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 |
| Sisters of Mary of the Presentation Long Term Care | ||||||||||
| 1202 Page Dr SW | Fargo | ND | 58103 | 752999939 | Provide extended care and medically related services | ND | 501(c)(3) | Line 10 | 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 12a, I | 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 | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| St Andrew's Bottineau Clinic LLC | ||||||||||||||
| 316 Ohmer Street | Bottineau | ND | 58318 | 450451306 | Provision of health care services | ND | St Andrew's Hospital | Related | -$107,925 | -$115,400 | 0 | 0 | 0.51000 | |
| 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 | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | 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 | Yes (1) | 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 | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Andrew's Bottineau Clinic LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | S | TransactionTypeTxt |
| Involved | $51,000 | InvolvedAmt |
| Method Of Amount Determination | General ledger | MethodOfAmountDeterminationTxt |