COAL COUNTRY COMMUNITY HEALTH CENTER: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- COAL COUNTRY COMMUNITY HEALTH CENTER (EIN 11-3686120)
- Tax period
- 2018-05-01 to 2019-04-30
- Filed
- 2019-11-05
- IRS object ID
- 201903099349300525
- 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 | 2019-11-05T08:21:46-06:00 | ReturnTs |
| Tax Period End | 2019-04-30 | 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 | 4310 17TH AVE S PO BOX 2545 | AddressLine1Txt |
| City | FARGO | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 581082545 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-05-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 113686120 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Coal Country Community Health Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COAL | BusinessNameControlTxt |
| Phone | 7018737788 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1312 Highway 49 N | AddressLine1Txt |
| City | Beulah | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 585236038 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Darrold Bertsch | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7018737788 | PhoneNum |
| Signature | 2019-11-04 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Deb Nelson CPA | PreparerPersonNm |
| PTIN | P01264758 | PTIN |
| Phone | 7012398500 | PhoneNum |
| Preparation | 2019-11-04 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 216.147.181.45 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-11-04 | IPDt |
| IP Tm | 08:22:59 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 66CC91E6B7F11C4783FFFA5645E675327CB67316 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 3F1B4C4A1C1F32CA3CD03C05270CE62742EA9E6E | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-04-17 16:48:07Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Darrold Bertsch | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1312 Highway 49 N | AddressLine1Txt |
| City | Beulah | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 585236038 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $12,887,438 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.coalcountryhealth.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2003 | FormationYr |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Activity Or Mission | CCCHC provides and promotes quality health care to the medically underserved population in the North Dakota counties of Mercer, Dunn, and Oliver. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 132 | TotalEmployeeCnt |
| Total Volunteers | 12 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,606,233 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,524,057 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $10,407,484 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,333,133 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $30,248 | CYOtherRevenueAmt |
| PY Total Revenue | $13,013,717 | PYTotalRevenueAmt |
| CY Total Revenue | $12,887,438 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $10,000 | 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 | $6,908,652 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,143,408 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,596,098 | PYOtherExpensesAmt |
| CY Other Expenses | $5,268,148 | CYOtherExpensesAmt |
| PY Total Expenses | $11,514,750 | PYTotalExpensesAmt |
| CY Total Expenses | $12,411,556 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,498,967 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $475,882 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $10,532,893 | TotalAssetsBOYAmt |
| Total Assets EOY | $13,591,246 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,428,541 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,011,012 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,104,352 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,580,234 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | CCCHC creates access to affordable high quality preventative and primary care for all, especially medically under-served populations in Dunn, Mercer, and Oliver counties. The organization links the established medical clinics of Beulah, Center, Killdeer, and Hazen together and efficiently uses resources available to meet the increasingly complex needs of delivering rural health and improving the health status of all. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $10,316,081 | ExpenseAmt |
| Revenue | $10,333,133 | RevenueAmt |
| Desc | Coal Country Community Health Center is part of a family of over 1,400 health centers nationally that provide care to more than 28 million people in the United States. Community health centers are local, non-profit health care providers serving low income and medically underserved communities. Also known as Federally-Qualified Health Centers (FQHCs), they are located in areas where care is needed, and improve access to care for millions of Americans. Their costs of care rank among the lowest, and their focus on prevention reduces the need for more expensive in-patient and specialty care, saving billions of dollars for taxpayers. (Continued on Schedule O)The focus of the care we provide can be summed up in one word - community. Coal Country is governed by a board of members from the communities we serve, and every decision they make has the best interest of the community in mind. Our medical staff and support staff are also your neighbors, helping us truly understand you and the health care issues that are important to you.The team of providers delivers primary care for the entire community. Funded by a federal grant, our sliding fee scale allows patients to pay according to their individual ability. This and other efforts ensure that no one in the community goes without proper health care services. That's what we're all about.Coal Country Community Health Center, with clinics in Beulah, Center, Hazen, and Killdeer, is a member of the PrimeCare Health Group. Furthermore, Coal Country remains a member of the other health care networks in the region.At Coal Country Community Health Center, our top priority is to provide complete health care services for the entire community.With a background in every area of medicine, our primary care physicians provide continuing and comprehensive care, from preventative care to diagnosis and treatment of health conditions.For more focused care, we bring in specialists to our clinic in Beulah,all the while continuing to oversee your total care.Our ongoing medical care of all levels includes the areas of::: Acute and chronic disease:: Adult care medicine:: Emergency medicine:: Geriatrics:: Mental health:: Medicated Assisted Therapy:: Obstetrics:: Occupational medicine:: Pediatrics:: Prenatal care:: Sports medicine:: Women's healthSpecialists from Bismarck regularly visit our clinics to provide treatment in the areas of::: Audiology:: Ear, nose and throat:: General surgery:: Mental health:: Obstetrics and Gynecology:: Orthopedics | Desc |
| Total Program Service Expenses | $10,316,081 | 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 | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | 0 | OperateHospitalInd |
| 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 | Yes (1) | 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 | 0 | 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 | 28 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 132 | 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 | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 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 | Dovie Borth | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7018737788 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1312 Hwy 49 N | AddressLine1Txt |
| City | Beulah | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 585236038 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Dr DJ Erickson | |||||||
| Chair | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Keith Johnson | |||||||
| Vice Chair | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Arlene Helling | |||||||
| Secretary/Treasurer | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Ann Mahoney -Director | |||||||
| Executive Committee | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Gordon Hoffner | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Fred Stern | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Sienna Sailer | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Jody Doe | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Anna Mae Batke | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Kathy Kelsch | |||||||
| Director (Began June 2018) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Travis Jordan | |||||||
| Director (Began June 2018) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Kimberly Kessler | |||||||
| Director (Resigned May 2018) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Darrold Bertsch | |||||||
| CEO | 22.10 | Yes (X) | $268,033 | $0 | $34,584 | ||
| Dovie Borth | |||||||
| CFO | 34.30 | Yes (X) | $94,157 | $0 | $12,132 | ||
| Aaron Garman MD | |||||||
| Physician | 40.00 | $343,432 | $0 | $32,416 | Yes (X) | ||
| Jacinta-Jon Klindworth MD | |||||||
| Physician | 40.00 | $263,887 | $0 | $35,567 | Yes (X) | ||
| Michelle Placke | |||||||
| Physician | 38.60 | $245,627 | $0 | $38,954 | Yes (X) | ||
| Rodney Zimmerman | |||||||
| Physician | 39.90 | $201,829 | $0 | $31,300 | Yes (X) | ||
| Orlan Jackson DO | |||||||
| Physician | 24.00 | $184,268 | $0 | $28,859 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,601,233 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $213,812 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 13 | 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 |
|---|---|---|---|---|---|
| Corval Management Services Inc | |||||
| 1633 Eustis St | St Paul | MN | 55108 | Construction for Beulah Clinic Expansion | $5,058,309 |
| Beulah Drug | |||||
| 147 W Main | Beulah | ND | 58523 | Contract Pharmacy Dispensing Fees | $878,974 |
| Sakakawea Medical Center | |||||
| 510 8th Avenue NE | Hazen | ND | 58545 | Shared Staff & Rent | $287,106 |
| Greenway Health LLC | |||||
| PO Box 203658 | Dallas | TX | 753203658 | Software Subscription, Support, Licenses | $185,784 |
| Hazen Drug | |||||
| 30 Main Street | Hazen | ND | 58545 | Contract Pharmacy Dispensing Fees | $179,445 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,524,057 | GovernmentGrantsAmt |
| Total Contributions | $2,524,057 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 621110 | $6,479,522 | $6,479,522 |
| 340B Program Revenue | 621110 | $3,412,015 | $3,412,015 |
| Other Program Revenue | 621110 | $441,596 | $441,596 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,333,133 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $30,248 | 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 | $30,248 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,248 | TotalRevenueColumnAmt |
| Exclusion | $30,248 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,887,438 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,333,133 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $30,248 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $270,302 | TotalAmt |
| Management And General | $270,302 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,579,518 | TotalAmt |
| Program Services | $5,234,394 | ProgramServicesAmt |
| Management And General | $345,124 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $206,245 | TotalAmt |
| Program Services | $155,875 | ProgramServicesAmt |
| Management And General | $50,370 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $697,941 | TotalAmt |
| Program Services | $565,178 | ProgramServicesAmt |
| Management And General | $132,763 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $389,402 | TotalAmt |
| Program Services | $277,207 | ProgramServicesAmt |
| Management And General | $112,195 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,986 | TotalAmt |
| Management And General | $7,986 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $94,970 | TotalAmt |
| Management And General | $94,970 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $529,315 | TotalAmt |
| Program Services | $412,531 | ProgramServicesAmt |
| Management And General | $116,784 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,337 | TotalAmt |
| Management And General | $67,337 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $600,014 | TotalAmt |
| Program Services | $319,114 | ProgramServicesAmt |
| Management And General | $280,900 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $295,519 | TotalAmt |
| Management And General | $295,519 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $296,514 | TotalAmt |
| Program Services | $278,326 | ProgramServicesAmt |
| Management And General | $18,188 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,167 | TotalAmt |
| Program Services | $36,601 | ProgramServicesAmt |
| Management And General | $24,566 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,258 | TotalAmt |
| Program Services | $7,208 | ProgramServicesAmt |
| Management And General | $16,050 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1 | TotalAmt |
| Program Services | $1 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $721,872 | TotalAmt |
| Program Services | $665,340 | ProgramServicesAmt |
| Management And General | $56,532 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,018 | TotalAmt |
| Management And General | $35,018 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $2,008,336 | $2,008,336 | |
| Bad Debt Expense | $209,481 | $209,481 | |
| Licenses | $58,692 | $54,600 | $4,092 |
| Dues and Subscriptions | $40,501 | $5,046 | $35,455 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $218,167 | TotalAmt |
| Program Services | $86,843 | ProgramServicesAmt |
| Management And General | $131,324 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,411,556 | TotalAmt |
| Program Services | $10,316,081 | ProgramServicesAmt |
| Management And General | $2,095,475 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,672,600 | BOYAmt |
| EOY | $4,169,143 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,356,205 | BOYAmt |
| EOY | $1,082,772 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,608 | BOYAmt |
| EOY | $53,258 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $97,447 | BOYAmt |
| EOY | $125,083 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $10,092,458 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,010,637 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,266,595 | BOYAmt |
| EOY | $8,081,821 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,438 | BOYAmt |
| EOY | $79,169 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,532,893 | BOYAmt |
| EOY | $13,591,246 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,428,541 | BOYAmt |
| EOY | $1,216,762 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $2,794,250 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,428,541 | BOYAmt |
| EOY | $4,011,012 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,104,352 | BOYAmt |
| EOY | $9,580,234 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,104,352 | BOYAmt |
| EOY | $9,580,234 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,532,893 | BOYAmt |
| EOY | $13,591,246 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $475,882 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,508,859 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,089,318 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,696,142 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,606,233 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,524,057 | CurrentTaxYearAmt |
| Total | $11,424,609 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,508,859 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,089,318 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,696,142 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,606,233 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,524,057 | CurrentTaxYearAmt |
| Total | $11,424,609 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $11,424,609 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | $30,248 | CurrentTaxYearAmt |
| Total | $30,248 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $11,454,857 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $44,411,612 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.99740 | PublicSupportCY170Pct |
| Public Support PY170 | 1.00000 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,089,183 | OtherCostOrOtherBasisAmt |
| Depreciation | $912,305 | DepreciationAmt |
| Book Value | $6,176,878 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $33,173 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,910 | DepreciationAmt |
| Book Value | $20,263 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,869,327 | OtherCostOrOtherBasisAmt |
| Depreciation | $992,436 | DepreciationAmt |
| Book Value | $876,891 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,100,775 | OtherCostOrOtherBasisAmt |
| Depreciation | $92,986 | DepreciationAmt |
| Book Value | $1,007,789 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,081,821 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $12,677,956 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$209,482 | OtherRevenueAmt |
| Revenue Not Reported | -$209,482 | RevenueNotReportedAmt |
| Revenue Subtotal | $12,887,438 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $12,887,438 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $12,202,074 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $12,202,074 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $209,482 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $209,482 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $12,411,556 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | The Health Center is organized as a North Dakota nonprofit organization 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 -209,482. |
| Part XII, Line 4b - Other Adjustments: | Provision for Bad Debts 209,482. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Darrold Bertsch | ||||||||||||||
| CEO | $263,769 | $0 | $0 | $0 | $4,264 | $0 | $10,631 | $0 | $22,045 | $0 | $300,709 | $0 | $0 | $0 |
| Aaron Garman MD | ||||||||||||||
| Physician | $278,600 | $0 | $64,022 | $0 | $810 | $0 | $10,781 | $0 | $22,481 | $0 | $376,694 | $0 | $0 | $0 |
| Jacinta-Jon Klindworth MD | ||||||||||||||
| Physician | $213,292 | $0 | $49,785 | $0 | $810 | $0 | $10,624 | $0 | $25,789 | $0 | $300,300 | $0 | $0 | $0 |
| Michelle Placke | ||||||||||||||
| Physician | $205,696 | $0 | $26,542 | $0 | $13,389 | $0 | $9,539 | $0 | $30,639 | $0 | $285,805 | $0 | $0 | $0 |
| Rodney Zimmerman | ||||||||||||||
| Physician | $183,282 | $0 | $14,356 | $0 | $4,191 | $0 | $7,346 | $0 | $21,103 | $0 | $230,278 | $0 | $0 | $0 |
| Orlan Jackson DO | ||||||||||||||
| Physician | $176,248 | $0 | $4,356 | $0 | $3,664 | $0 | $7,224 | $0 | $19,711 | $0 | $211,203 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 6 | An annual management team incentive program was started in FY2014 with the first annual payment occurring in August 2014 for fiscal year ending 04/30/2014. This program was continued for FY2019. The incentive payment is based on a combination of ten clinical and financial performance measures relating to the patient population and the health center. The ten measures are: 1. Diabetes Control > National Average 2. Blood Pressure Control > National Average 3. Cholesterol Treatment > National Average 4. Adult Weight Screening & Follow-up > National Average 5. Childhood Immunizations > National Average 6. Days in AR < 55 7. Days Cash on Hand > 90 8. Net Profit Margin > 5% 9. Long Term Debt to Equity < .50 10. Medical Cost Per Medical Patient < National Average Of the 10 measures, only net profit margin could potentially be considered as compensation contingent on net earnings. Only the measures met for the current fiscal year are included in the calculation of the incentive payment. Each measure met receives a rating of 1%. A maximum incentive of 10% is allowed. The incentive payment calculation is based on the individual team member's base salary/wages as of the end of the current fiscal year. Dovie Borth received a management team incentive payment of $8,830.20 for FY2018 which was paid in FY2019. The other four participants in the program do not meet the criteria for Part VII and are not listed in Part VII. |
| Schedule J, Part II: | As of 6/1/2013, Darrold became an employee of Coal Country Community Health Center (CCCHC) and still provides services to both Sakakawea Medical Center (SMC) and CCCHC. The compensation reported in Part VII, and Part II of Schedule J, reflects total compensation Darrold received from CCCHC for his services to both SMC and CCCHC. Compensation received just for services to CCCHC, includes $167,801 of wages and benefits. |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Union Bank | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship With Org | Family Member of Board Member (Gordon Hoffner) owns > 35% of Union Bank | RelationshipWithOrgTxt |
| Loan Purpose | Construction | LoanPurposeTxt |
| Loan To Organization | Yes (X) | LoanToOrganizationInd |
| Original Principal | $2,794,250 | OriginalPrincipalAmt |
| Balance Due | $2,794,250 | BalanceDueAmt |
| Default | 0 | DefaultInd |
| Board Or Committee Approval | Yes (1) | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (1) | WrittenAgreementInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $2,794,250 | TotalBalanceDueAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, line 2 | CCCHC began providing mental health services in the Beulah and Hazen school districts during the 2018-2019 school year. The health center utilizes a comprehensive mental health screening tool at each school district as an approach for early identification of conditions that increase risk for substance or opioid use in adolescent patients. In the fall of 2018, Tobacco Treatment Specialists (TTS) began providing education and cessation counseling to patients seen at the health center. Patients are able to receive tobacco cessation counseling, support, and services through these specialists. A Certified Diabetic Educator (CDE) started providing diabetic education services in January 2019. The CDE promotes self-management to achieve individualized behavioral and treatment goals that reduce risks and optimize health outcomes. CCCHC began providing medical services at Hilltop Home of Comfort, the long term care facility, in Killdeer, ND in October 2018. CCCHC added a dedicated medical provider to provide services at Knife River Care Center, the long term care facility, in Beulah, ND. |
| Form 990, Part VI, Section A, line 1 | The Executive Committee shall consist of at least five (5) voting members, including the Chair, Vice Chair, Secretary, Treasurer, and one (1) at-large member. The Executive Director of the Corporation shall serve without voting powers. The Executive Committee shall have the power to transact all business of the Corporation during the interim between meetings of the Board of Directors, provided that any action so taken shall not conflict with the policies and express wishes of the Board of Directors, and that it shall refer all matters of major importance to the full Board of Directors, including any amendments to the Articles and Bylaws. |
| Form 990, Part VI, Section B, line 11b | The full copy of the Form 990 is provided to the board via email. The Form 990 is reviewed and approved by the board and signed by the CEO after approval. |
| Form 990, Part VI, Section B, line 12c | The conflict of interest and compensation disclosure statements are completed annually. All board members and officers of CCCHC are covered by the policy. The annual conflict of interest and compensation disclosure statements obtained from board members and officers of CCCHC are reviewed by the CEO and Administration staff of CCCHC. It is at this review that the determination is made as to whether a conflict exists. Actual conflicts of interest identified are brought before the Board Executive Committee or the entire Board, depending on the situation and circumstances. Board members and officers of CCCHC are required to recuse themselves from voting on issues where it has been determined that a conflict of interest does exist. If the conflict of interest is pervasive, the Board Executive Committee or the entire Board will determine if further actions are needed. In all situations, the Board will document the restrictions imposed or acted upon. |
| Form 990, Part VI, Section B, line 15a | To determine compensation, the organization uses the following salary surveys for both the CEO and CFO as well as other positions within the organization: National Community Health Center Association (NACHC), Community Healthcare Association of the Mountain Plain States (CHAMPS), Medical Group Management Association (MGMA), and state of ND. The board of directors determines the salary of the CEO. CEO Salary adjustments are documented on a payroll notification form, signed by the board chair and forwarded to the accounting department for entry into the accounting/payroll system. Compensation for the CFO is reviewed and approved by the CEO. The board of directors approves an annual budget to provide guidance for expenditures which includes personnel salaries. In addition, annual salary adjustments are presented to the board for approval. Personnel salary adjustments are documented on a payroll notification form signed by the CEO or Human Resources and forwarded to the accounting department for entry into the accounting/payroll system. The process for determining compensation is undertaken annually before the new fiscal year in May begins. |
| Form 990, Part VI, Section C, line 19 | The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. |
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