HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME (EIN 41-0307617)
- Tax period
- 2017-07-01 to 2018-06-30
- Filed
- 2019-01-30
- IRS object ID
- 201900309349300210
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-01-30T09:02:40-06:00 | ReturnTs |
| Tax Period End | 2018-06-30 | 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 | 2017-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410307617 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hendricks Community Hospital Assn | BusinessNameLine1Txt |
| Business Name Line2 | & Retirement Home | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HEND | BusinessNameControlTxt |
| Phone | 5072753134 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 106 | AddressLine1Txt |
| City | Hendricks | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56136 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jeff Gollaher | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5072753134 | PhoneNum |
| Signature | 2019-01-29 | 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 | 2019-01-29 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 8.39.233.75 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-01-29 | IPDt |
| IP Tm | 13:28:09 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | F9BEE9501A3B4F00F190E63700B8BF2BC70C7B96 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Jeff Gollaher | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 106 | AddressLine1Txt |
| City | Hendricks | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56136 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,341,718 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.hendrickshosp.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1941 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | Provision of healthcare | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 224 | TotalEmployeeCnt |
| Total Volunteers | 75 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $58,168 | PYContributionsGrantsAmt |
| CY Contributions Grants | $96,475 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $14,227,621 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $13,806,010 | CYProgramServiceRevenueAmt |
| PY Investment Income | $40,460 | PYInvestmentIncomeAmt |
| CY Investment Income | $326,403 | CYInvestmentIncomeAmt |
| PY Other Revenue | $64,506 | PYOtherRevenueAmt |
| CY Other Revenue | $68,507 | CYOtherRevenueAmt |
| PY Total Revenue | $14,390,755 | PYTotalRevenueAmt |
| CY Total Revenue | $14,297,395 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $7,944 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $27,095 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,940,137 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,005,963 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,794,408 | PYOtherExpensesAmt |
| CY Other Expenses | $6,313,852 | CYOtherExpensesAmt |
| PY Total Expenses | $13,742,489 | PYTotalExpensesAmt |
| CY Total Expenses | $14,346,910 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $648,266 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$49,515 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $16,886,090 | TotalAssetsBOYAmt |
| Total Assets EOY | $17,637,117 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,062,558 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,805,245 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $14,823,532 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $14,831,872 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Hendricks Community Hospital Assn & Retirement Home strives to provide the highest quality health and residential care in a Christian environment. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $12,865,158 | ExpenseAmt |
| Grant | $27,095 | GrantAmt |
| Revenue | $13,823,527 | RevenueAmt |
| Desc | Hendricks Community Hospital, a 24-bed hospital, 58-bed long-term care facility, 16-unit senior rental housing facility, and home health agency promotes health of the community by providing a variety of health care services. The facility had 74 acute, 49 swing bed, 10 transitional bed and 22 long-term care facility admissions for the year ended June 30, 2018; 470 visits to the Emergency Room; and 140 surgical cases (including ambulatory). The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Continued on Schedule O.Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as patient and resident service revenue. The amount of charges foregone for services provided under the Hospital's charity care policy were approximately $15,000 for the year ended June 30, 2018. The estimated cost of providing these services was $12,000 for the year ended June 30, 2018, based on average ratio of cost to gross charges. | Desc |
| Total Program Service Expenses | $12,865,158 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | 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 | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 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 | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | 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 | 42 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 224 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 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 |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Julie Hogie | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5072753134 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 106 | AddressLine1Txt |
| City | Hendricks | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56136 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 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 |
|---|---|---|---|---|---|---|---|
| Allen Molascon | |||||||
| President | 3.00 | Yes (X) | Yes (X) | $660 | $0 | $0 | |
| Mark VanEck | |||||||
| Vice President | 2.00 | Yes (X) | Yes (X) | $630 | $0 | $0 | |
| Julie Leibfried | |||||||
| Secretary | 2.00 | Yes (X) | Yes (X) | $460 | $0 | $0 | |
| Vince Robinson | |||||||
| Treasurer | 2.00 | Yes (X) | Yes (X) | $480 | $0 | $0 | |
| Norris Patrick | |||||||
| Director | 2.00 | Yes (X) | $380 | $0 | $0 | ||
| Sharon Vettrus | |||||||
| Director (thru Aug 2017) | 2.00 | Yes (X) | $280 | $0 | $0 | ||
| Miriam Iverson | |||||||
| Director | 2.00 | Yes (X) | $520 | $0 | $0 | ||
| James Ness | |||||||
| Director | 2.00 | Yes (X) | $540 | $0 | $0 | ||
| Dean Nielsen | |||||||
| Director | 2.00 | Yes (X) | $460 | $0 | $0 | ||
| John Engels | |||||||
| Director (as of Aug 2017) | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| Jeff Gollaher | |||||||
| CEO | 40.00 | Yes (X) | $170,369 | $0 | $19,115 | ||
| Julie Hogie | |||||||
| Business Office Manager | 40.00 | Yes (X) | $65,619 | $0 | $13,370 | ||
| Tabb McCluskey | |||||||
| Physician/Medical Director | 40.00 | $169,234 | $0 | $40,311 | Yes (X) | ||
| Grant Eyjolfson | |||||||
| Physician | 40.00 | $329,094 | $0 | $40,974 | Yes (X) | ||
| Tomasz Lis | |||||||
| Physician | 40.00 | $405,538 | $0 | $41,838 | Yes (X) | ||
| Kathryn Christensen | |||||||
| Nurse Practitioner | 40.00 | $116,904 | $0 | $5,765 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,261,168 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $161,373 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| A'viands LLC | |||||
| PO Box 743357 | Atlanta | GA | 303743357 | Contracted dietary services | $860,212 |
| WMG Lyfjaberg LLC | |||||
| 603 S Dakota St PO Box 523 | Milbank | SD | 57252 | Locum/ER providers | $556,281 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $12,400 | FundraisingAmt |
| Government Grants | $69,860 | GovernmentGrantsAmt |
| All Other Contributions | $14,215 | AllOtherContributionsAmt |
| Total Contributions | $96,475 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Net patient & resident service re | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $13,735,417 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,735,417 | RelatedOrExemptFuncIncomeAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $70,593 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $70,593 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $13,806,010 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,547 | TotalRevenueColumnAmt |
| Exclusion | $19,547 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $9,102 | 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 | $9,102 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,102 | TotalRevenueColumnAmt |
| Exclusion | $9,102 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $345,830 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $38,974 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $306,856 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $306,856 | TotalRevenueColumnAmt |
| Exclusion | $306,856 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $5,463 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $12,400 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $3,976 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,487 | TotalRevenueColumnAmt |
| Exclusion | $1,487 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $41,774 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $1,373 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $40,401 | TotalRevenueColumnAmt |
| Exclusion | $40,401 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | AR Interest | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $17,517 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,517 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $17,517 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,297,395 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,823,527 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $377,393 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,095 | TotalAmt |
| Program Services | $27,095 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $272,893 | TotalAmt |
| Management And General | $272,893 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,279 | TotalAmt |
| Program Services | $40,279 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,760,628 | TotalAmt |
| Program Services | $5,573,378 | ProgramServicesAmt |
| Management And General | $187,250 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,189 | TotalAmt |
| Program Services | $148,059 | ProgramServicesAmt |
| Management And General | $9,130 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,350,074 | TotalAmt |
| Program Services | $1,233,746 | ProgramServicesAmt |
| Management And General | $116,328 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $424,900 | TotalAmt |
| Program Services | $394,283 | ProgramServicesAmt |
| Management And General | $30,617 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,570 | TotalAmt |
| Management And General | $57,570 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,510,453 | TotalAmt |
| Program Services | $2,390,601 | ProgramServicesAmt |
| Management And General | $119,852 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,403 | TotalAmt |
| Program Services | $1,034 | ProgramServicesAmt |
| Management And General | $29,369 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $741,343 | TotalAmt |
| Program Services | $700,301 | ProgramServicesAmt |
| Management And General | $41,042 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,570 | TotalAmt |
| Program Services | $17,570 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $295,859 | TotalAmt |
| Program Services | $293,000 | ProgramServicesAmt |
| Management And General | $2,859 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,939 | TotalAmt |
| Program Services | $84,058 | ProgramServicesAmt |
| Management And General | $5,881 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,804 | TotalAmt |
| Program Services | $23,804 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $628,009 | TotalAmt |
| Program Services | $628,009 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $221,119 | TotalAmt |
| Management And General | $221,119 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Repairs and Maintenance | $678,391 | $599,361 | $79,030 |
| Medical Supplies | $492,611 | $492,611 | |
| MN Care Tax | $270,048 | $270,048 | |
| Bad Debt Expense | $62,486 | $62,486 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $194,247 | TotalAmt |
| Program Services | $155,483 | ProgramServicesAmt |
| Management And General | $38,764 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,346,910 | TotalAmt |
| Program Services | $12,865,158 | ProgramServicesAmt |
| Management And General | $1,481,752 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,143,177 | BOYAmt |
| EOY | $1,255,403 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,703,331 | BOYAmt |
| EOY | $1,628,866 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,000 | BOYAmt |
| EOY | $50,931 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $98,880 | BOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $262,404 | BOYAmt |
| EOY | $276,868 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $84,215 | BOYAmt |
| EOY | $62,916 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $25,435,474 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $13,023,600 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,744,383 | BOYAmt |
| EOY | $12,411,874 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,624,171 | BOYAmt |
| EOY | $1,924,268 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,929 | BOYAmt |
| EOY | $25,991 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $78,600 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,886,090 | BOYAmt |
| EOY | $17,637,117 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,230,514 | BOYAmt |
| EOY | $1,338,871 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,042 | BOYAmt |
| EOY | $26,042 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,000 | BOYAmt |
| EOY | $490,304 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $755,002 | BOYAmt |
| EOY | $950,028 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,062,558 | BOYAmt |
| EOY | $2,805,245 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,823,532 | BOYAmt |
| EOY | $14,831,872 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,823,532 | BOYAmt |
| EOY | $14,831,872 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,886,090 | BOYAmt |
| EOY | $17,637,117 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$49,515 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $58,451 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$596 | 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 | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $97,714 | BeginningBalanceAmt |
| Additions During Year | $41,953 | AdditionsDuringYearAmt |
| Distributions During Year | $41,357 | DistributionsDuringYearAmt |
| Ending Balance | $98,310 | EndingBalanceAmt |
| 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 | $94,512 | OtherCostOrOtherBasisAmt |
| Book Value | $94,512 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,072,024 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,732,134 | DepreciationAmt |
| Book Value | $4,339,890 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,292,590 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,291,466 | DepreciationAmt |
| Book Value | $1,001,124 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,976,348 | OtherCostOrOtherBasisAmt |
| Book Value | $6,976,348 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $12,411,874 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Construction payable | $930,934 |
| Estimated third-party payor settlements | $19,094 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $950,028 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $14,226,090 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$30,725 | OtherRevenueAmt |
| Revenue Not Reported | -$30,725 | RevenueNotReportedAmt |
| Revenue Subtotal | $14,256,815 | RevenueSubtotalAmt |
| Other Revenues Not Included | $40,580 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $40,580 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $14,297,395 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $14,276,201 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $14,276,201 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $70,709 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $70,709 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $14,346,910 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 1b: | The assets of Hendricks Hospital Auxiliary are held by Hendricks Community Hospital Association. The Auxiliary uses the EIN of the Hospital, therefore the activity is reported on Form 990 of the Hospital. The ending balance for the Auxiliary was $93,136. In addition, the Hospital holds funds on behalf of its residents. The amount held at the end of the year for residents was $5,174. |
| Part IV, Line 2b: | The organization holds security deposits. |
| Part X, Line 2: | The Association is organized as a Minnesota not-for-profit 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 Association is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Association is subject to income tax on any net income that is derived from business activities that are unrelated to its exempt purpose. The Association 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 Association believes 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 consolidated financial statements. The Association 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: | Bad debt expense reported in revenue on financial statements -62,486. Expenses reported in contributions on financial statements -5,239. Auxiliary contributions to Hospital not reported on Form 990 37,000. |
| Part XI, Line 4b - Other Adjustments: | Auxiliary revenue not included in financial statements 41,953. Auxiliary Thrift shop expenses reported in revenue on Form 990 -1,373. |
| Part XII, Line 4b - Other Adjustments: | Auxiliary expenses not included in financial statements 2,576. Bad debt expense reported in revenue on financial statements 62,486. Expenses reported as contributions on financial statements 5,239. Resident fund expenses not included in financial statements 408. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Hospice Tour of Tables | Event1Nm |
| Gross Receipts Event1 | $11,522 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $8,400 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $3,122 | GrossRevenueEvent1Amt |
| Food And Beverage Event1 | $2,415 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $299 | OtherDirectExpensesEvent1Amt |
| Event2 | Hospice Golf Tournament | Event2Nm |
| Gross Receipts Event2 | $6,341 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $4,000 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $2,341 | GrossRevenueEvent2Amt |
| Food And Beverage Event2 | $626 | FoodAndBeverageEvent2Amt |
| Other Direct Expenses Event2 | $636 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $17,863 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $12,400 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $5,463 | GrossRevenueTotalEventsAmt |
| Food And Beverage Total Events | $3,041 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $935 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $3,976 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $1,487 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 125.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | 0 | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $12,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,224,390 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,699,716 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $524,674 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03670 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,236,390 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,699,716 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $536,674 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03750 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,621 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $12,621 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $63,312 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $63,312 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00440 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,719,671 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,488,618 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,231,053 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15620 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $27,095 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $27,095 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,822,699 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,488,618 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,334,081 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.16340 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,059,089 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,188,334 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,870,755 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.20090 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $62,486 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $31,243 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,763,696 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,765,610 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,914 | 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 | Hendricks Community Hospital Association | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 503 East Lincoln | AddressLine1Txt |
| City | Hendricks | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56136 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.hendrickshosp.org | WebsiteAddressTxt |
| State License | 00340 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | 2 provider based RHCs | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hendricks Community Hospital Association | 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 | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | 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 | www.hendrickshosp.org | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.hendrickshosp.org | 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 | 125.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| 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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.hendrickshosp.org/patientinfo.html | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.hendrickshosp.org/patientinfo.html | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.hendrickshosp.org/patientinfo.html | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Hendricks Community Hospital Association | Part V, Section B, Line 5: Four focus groups were formulated to provide input in completion of the current Community Health Needs Assessment. Participants in those groups included business/community leaders, health care providers (including public health), seniors and young parents. A total of 24 individuals were interviewed. |
| Hendricks Community Hospital Association | Part V, Section B, Line 11: Members of the hospital board and facility leadership team have met to identify the top community health needs and conduct strategic planning. The team has rated the community health needs based on the ability of the facility to respond to the needs of the community. Team members continue to strategize on how best to address the objectives and needs as presented. The facility leadership teams are meeting on an on-going basis to move the strategies forward.Of the community health needs identified, the hospital will address: Awareness of Services; Staff Recognition, Affordable Care; Wellness Promotion, and Mental Health Needs.The Hospital will not address Drug and Alcohol Abuse since it is not feasible with current resources.The following updates took place during the fiscal year ending June 30, 2018:1. Expanding Market Strategiesa. Social media options implemented - utilizing facebook, community digital sign and facility website. Lung cancer screenings are promoted in news media.2. Foster Internal Culture of Appreciation & Developmenta. In addition to new employee orientation, in-house new staff group training is taking place on a monthly basis, as well as 30/60/90 day check-ins with new hires.b. Scholarship availabilities promoted.c. Encourage participation in Medi-Sota workshops and webinars3. Community Wellnessa. Dietary department is providing healthy meal choicesb. Discounted rate for staff to utilize community exercise center4. Mental Health Servicesa. Continued study is taking place for psychiatric tele-health servicesa. Law enforcement and area facility representatives have held meetings to study avenues of improving availability of mental health services.5. Financial Stewardshipa. Departmental year-to-date budgets are being distributed quarterly.b. Volunteer coordinator is regularly promoting utilization of volunteers |
| Hendricks Community Hospital Association | Part V, Section B, Line 13h: Discounted care eligibility is determined by utilizing asset and ability to pay information obtained from the patient or responsible party. Discounted care portion of the account is determined based on the patient's financial status and ability to pay the account. |
| Hendricks Community Hospital Association | Part V, Section B, Line 16j: Summaries of the financial assistance policy are posted in the hospital/clinic facilities, as well as waiting rooms and admission area. Billing statements to potentially eligible clients also include summary and contact information for obtaining the appropriate application. |
| 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 - Hendricks Nursing Home | ||||
| 503 E Lincoln St | Hendricks | MN | 56136 | Long term care |
| 2 - Lincoln Lane Villa | ||||
| 500 E Lincoln St | Hendricks | MN | 56136 | Senior Housing |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | Discounted care eligibility is determined by utilizing asset and ability to pay information obtained from the patient or responsible party. Discounted care portion of the account is determined based on the patient's financial status and ability to pay the account. |
| Part I, Line 7: | Charity care is based on an overall cost to charge ratio addressing all patient segments. Community health improvement services, health professions education, and cash and in-kind contributions for community benefit expenses are based on actual expenses recorded to the general ledger. Subsidized health services are reported according to costs allocated to the relevant cost centers on the Medicare Cost Report. |
| Part I, Ln 7 Col(f): | The amount of bad debt expense removed from the denominator of the calculation was $62,486. |
| Part II, Community Building Activities: | Many leaders and staff of the hospital are involved with local community groups like Kiwanis and other community clubs. Their involvement provides them the opportunity to get involved in speaking to community members on health topics and encouraging community involvement in other health activities, like blood drives. Funds were used to host an appreciation dinner and for physician recruitment. |
| Part III, Line 2: | Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces the bad debt expense in the current year. Bad debt expense on line 2 is reported at charges as presented on the financial statements. |
| Part III, Line 3: | Bad debt expense is determined based on a patient's payment history as well as current known financial status. Such expense is determined by a patient's non-payment status and non-probability of payment. Because of the nature of these accounts, it is found that at least 50% of these accounts would fall into the charity care status. |
| Part III, Line 4: | The footnote to the organization's financial statements that describes bad debt expense is located on page 7 of the attached financial statements. |
| Part III, Line 8: | The Hospital provides services to Medicare patients because access to healthcare and patient's health is important to the Hospital. 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 the Centers for Medicare and Medicaid Services. |
| Part III, Line 9b: | Patients are classified in the poverty level utilizing the Federal poverty guidelines as also referenced in our facility collection policy. The guidelines are referenced when a patient fails to complete payment of his/her account in a timely manner. Prior to being turned over to a collection agency, a patient is offered 120 days to complete a charity care application, thereby allowing staff time to determine the income level of the patient and their qualification as a poverty level individual. If they so chose to not complete an application, their account would be referred to a collection agency. The Hospital allows an additional 120 days for a patient to apply for financial assistance. If the patient is determined to be eligible for financial assistance collection activities will cease. |
| Part VI, Line 2: | We are consistently addressing the additional service needs as voiced through the physicians who serve our clientele, as well as the clientele themselves.The community health needs assessment and implementation strategy have been completed and are available on our website at www.hendrickshosp.org. |
| Part VI, Line 3: | Patient's insurance information is obtained upon admission, and those patients not having current third party coverage are informed of the ability to apply for medical assistance funding or visit with our business office staff and social service staff regarding alternative payments and the charity care options. In addition, the patient statements provide information related to contacting our business office personnel to complete alternative payment arrangements, i.e. charity care, Medicaid or planned payment schedule. Patients are offered an option of setting an appointment to meet with staff to complete such arrangements. These procedures are also detailed in our financial assistance/charity care policy. |
| Part VI, Line 4: | Hendricks Community Hospital serves a primarily rural population within a 30-mile radius of the community of Hendricks. The facility is located in Lincoln County, Minnesota, which is slated as one of the highest elderly population counties in the State. The average median income for the county is $49,438 with the highest portion of the population being over 65 years of age. However, because of the high elderly population, many of those constituents are insured through federal government programs and do not necessarily relate to increased Medicaid levels. There is one other acute care facility in the county approximately 30 miles away. Our facility is also located within one-mile of the South Dakota border, and a good margin of population served is located in that state. During the fiscal year ending 6/30/18, it was noted approximately 22% of our patients were insured through Medical Assistance programs, and approximately 11% were un-insured. |
| Part VI, Line 5: | The nine members of the association's Board of Directors represent varying communities within the 30-mile service area. The board members provide valuable input of the health care needs of the area served.Medical staff privileges are extended to qualified physicians within the service area as well as outlying areas to provide the optimum level of care for our constituents. These privileges are granted to several specialty physicians to eliminate the need for additional travel for our patients.The Association continually allocates funds to the improvement of the facilities and equipment utilized to provide the optimum service to our patients. Surplus funds are also provided to enhance community services with donations to service organizations who offer additional health-enhancing services to the residents of the area. The rural health clinics in the Hendricks community and neighboring Ivanhoe community provide for improved community access. Particularily in the Ivanhoe community it has proved beneficial to be able to offer services in their primary dwelling location.Emergency room services are available 24/7, and are offered regardless of payment source or ability to pay.The facility also participates in the Minnesota SAGE and South Dakota All Women County programs which offer women yearly physical exams, including mammograms and pap smears at no cost to the patient.Facility staff is involved in community economic planning groups as well as community service organizations.Many area residents are involved as volunteers within our organization and participate on a daily basis enhancing the lives of the residents and patients in our facility. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | City of Hendricks | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 207 S Division Street | AddressLine1Txt |
| City | Hendricks | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56136 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 416005227 | RecipientEIN |
| IRC Section | City of Hendricks | IRCSectionDesc |
| Cash Grant | $20,000 | CashGrantAmt |
| Purpose Of Grant | City street repairs | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | The City of Hendricks received a $20,000 grant to be used for city street repairs due to damage from the construction equipment utilizing the streets during the Hospital's construction project. Other grants and assistance are given on an as needed basis with the board approval as part of the financial statement process. Grants are given for health and wellness and community improvements in the area as the administration and board deem appropriate. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jeff Gollaher | ||||||||||||||
| CEO | $170,369 | $0 | $0 | $0 | $0 | $0 | $6,969 | $0 | $12,146 | $0 | $189,484 | $0 | $0 | $0 |
| Tabb McCluskey | ||||||||||||||
| Physician/Medical Director | $169,234 | $0 | $0 | $0 | $0 | $0 | $7,496 | $0 | $32,815 | $0 | $209,545 | $0 | $0 | $0 |
| Grant Eyjolfson | ||||||||||||||
| Physician | $329,094 | $0 | $0 | $0 | $0 | $0 | $10,800 | $0 | $30,174 | $0 | $370,068 | $0 | $0 | $0 |
| Tomasz Lis | ||||||||||||||
| Physician | $405,538 | $0 | $0 | $0 | $0 | $0 | $10,800 | $0 | $31,038 | $0 | $447,376 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (2 entries)
| Relationship With OrgRelationshipWithOrgTxt | Loan PurposeLoanPurposeTxt | Loan From OrganizationLoanFromOrganizationInd | Original PrincipalOriginalPrincipalAmt | Balance DueBalanceDueAmt | DefaultDefaultInd | Board Or Committee ApprovalBoardOrCommitteeApprovalInd | Written AgreementWrittenAgreementInd |
|---|---|---|---|---|---|---|---|
| Grant Eyjolfson | |||||||
| Employee | Physician Recruitment | Yes (X) | $100,000 | $12,500 | 0 | Yes (1) | Yes (1) |
| Kathryn Christensen | |||||||
| Employee | Nurse Practioner Recruitment | Yes (X) | $45,000 | $38,431 | 0 | Yes (1) | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $50,931 | TotalBalanceDueAmt |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Katie Wendinger | |||
| Family member of board member Dean Nielsen | $29,349 | Employee compensation | 0 |
| Betty Johnson | |||
| Family member of board member Dean Nielsen | $10,930 | Employee compensation | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | The Executive Committee is composed of the President, Vice-President, Secretary and Treasurer of the governing board. Responsibilities include: A. General management and control of the affairs of the corporation. In addition to formal meetings, the committee has informal conferences about corporation activities. B. Shall have the power to transact all regular business of the hospital during the interim between the meetings of the Board of Directors provided any action taken shall not conflict with the policies and expressed wishes of the Board of Directors, and that it shall refer all matters of major importance to the Board of Directors. C. It shall cause to be prepared and submit to the Board of Directors at its last meeting before the end of the fiscal year, a budget showing the expected receipts and income and expense for the ensuing year. It shall be the further duty of the Executive Committee to examine the monthly financial reports and to require an explanation from the Administrator for any material variation from the budget. D. The Executive Committee shall evaluate in April annually or as deemed necessary, the Chief Executive Officer's performance and recommend his/her remuneration to the full Board of Directors. This committee shall meet as necessary. |
| Form 990, Part VI, Section A, line 2 | Matt Amundson and George Jorgensen have a business relationship. Matt Amundson and Vince Robinson have a business relationship. |
| Form 990, Part VI, Section A, line 6 | There is one class of membership. Membership is open to any natural person who is of legal voting age and a voting resident within the organization's primary service area. |
| Form 990, Part VI, Section A, line 7a | Each member receives one vote. |
| Form 990, Part VI, Section B, line 11b | The return is reviewed by the Business Office Manager and CEO, then by the Board of Directors before it is filed. |
| Form 990, Part VI, Section B, line 12c | The policy covers all officers, directors, and key employees. A conflict of interest form is signed upon orientation to the Board of Directors. The form is reviewed by the CEO and any potential conflicts are reviewed with the Board of Directors. If a conflict exists, the person with the conflict is restricted from voting on related matters. Conflict of interest forms are completed annually by board of directors and key employees. These are reviewed by the HR director, and compliance report submitted to the governing board. |
| Form 990, Part VI, Section B, line 15a | The Executive Committee reviews the CEO's compensation annually and compares to similar positions at other hospitals of similar size and geographic location. The Board of Directors reviews and approves the recommendations of the Executive Committee. This process was last evaluated in 2016. The officers of the board receive a stipend for attending meetings. The fee structure is based on meetings attended. This compensation process is determined by board members and the fee schedule is discussed by the board annually. |
| 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. |
| Form 990, Part IX, line 11g | Contracted services: Program service expenses 946,447. Management and general expenses 0. Fundraising expenses 0. Total expenses 946,447. Medical fees: Program service expenses 367,102. Management and general expenses 0. Fundraising expenses 0. Total expenses 367,102. Purchased services: Program service expenses 1,077,052. Management and general expenses 48,447. Fundraising expenses 0. Total expenses 1,125,499. Collection fees: Program service expenses 0. Management and general expenses 8,093. Fundraising expenses 0. Total expenses 8,093. Recruitment: Program service expenses 0. Management and general expenses 63,312. Fundraising expenses 0. Total expenses 63,312. |
| Form 990, Part XI, line 9: | Change in net assets for Hendricks Hospital Auxiliary -1,004. Change in net assets for resident funds 408. |