LUTHERAN CHARITY ASSOCIATION: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- LUTHERAN CHARITY ASSOCIATION (EIN 45-0231181)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-03-02
- IRS object ID
- 201720619349300322
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-03-02T10:56:20-06:00 | ReturnTs |
| Tax Period End | 2016-06-30 | 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 | 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 | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450231181 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Lutheran Charity Association | BusinessNameLine1Txt |
| Business Name Line2 | D/B/A Jamestown Regional Medical Center | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LUTH | BusinessNameControlTxt |
| Phone | 7012521050 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2422 20th Street SW | AddressLine1Txt |
| City | Jamestown | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 584013360 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Beverly Fiferlick | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7012521050 | PhoneNum |
| Signature | 2017-02-23 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LISA CHAFFEE CPA | PreparerPersonNm |
| PTIN | P00193453 | PTIN |
| Phone | 7012398500 | PhoneNum |
| Preparation | 2017-02-23 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jamestown Regional Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Beverly Fiferlick | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2422 20th Street SW | AddressLine1Txt |
| City | Jamestown | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 584013360 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $45,097,532 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.jrmcnd.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1927 | FormationYr |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Activity Or Mission | Jamestown Regional Medical Center will be the best rural hospital in the country for patients to receive care, employees to work, and physicians to practice. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 416 | TotalEmployeeCnt |
| Total Volunteers | 99 | TotalVolunteersCnt |
| Total Gross UBI | $47,075 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$852 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $110,775 | PYContributionsGrantsAmt |
| CY Contributions Grants | $64,612 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $41,687,273 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $44,112,579 | CYProgramServiceRevenueAmt |
| PY Investment Income | $490,652 | PYInvestmentIncomeAmt |
| CY Investment Income | $822,217 | CYInvestmentIncomeAmt |
| PY Other Revenue | $66,782 | PYOtherRevenueAmt |
| CY Other Revenue | $48,099 | CYOtherRevenueAmt |
| PY Total Revenue | $42,355,482 | PYTotalRevenueAmt |
| CY Total Revenue | $45,047,507 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $50 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $19,841,981 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $21,262,533 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $23,324,132 | PYOtherExpensesAmt |
| CY Other Expenses | $22,662,913 | CYOtherExpensesAmt |
| PY Total Expenses | $43,166,113 | PYTotalExpensesAmt |
| CY Total Expenses | $43,925,496 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$810,631 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,122,011 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $72,369,662 | TotalAssetsBOYAmt |
| Total Assets EOY | $72,221,248 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $52,721,657 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $51,313,306 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $19,648,005 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $20,907,942 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Exceed expectations and be the difference in the lives of those we serve. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $39,702,058 | ExpenseAmt |
| Grant | $50 | GrantAmt |
| Revenue | $44,072,409 | RevenueAmt |
| Desc | Jamestown Regional Medical Center is a 25 bed critical access hospital providing short-term acute inpatient, outpatient, swing bed, home health and hospice health care services. The nearest provider of health care services is more than 35 miles away and Jamestown Regional Medical Center is located 100 miles away from the nearest major health service centers in Fargo or Bismarck, North Dakota. Jamestown Regional Medical Center makes medical care accessible to the entire community it serves. In addition to the routine inpatient and outpatient health care services provided, during FYE June 30, 2016 the following were provided: *4,263 inpatient days of which 462 were swing bed and 18 hospice days of care *39% Medicare is the percentage of inpatient days *12% Medicaid is the percentage of inpatient days *8,701 emergency visits of which 723 resulted in inpatient admissions *32,501 total outpatient visits *2,308 outpatient surgical procedure visits including outpatient surgery and scopes *337 live births *2,051 orthopedic patients*753 urology patients *2,124 cardiac rehab visits *4,355 home health visits *4,928 hospice days of care *$461,538 in free care *99 volunteers We provide the following specialty services to the communities we serve:*Urology: Treatment of conditions associated with the kidney, bladder and urinary tract. *Wound Clinic: We offer advanced wound care solutions to patients dealing with the issue of wound healing.*Cardiac care and rehabilitation: In addition to emergency and intensive care units our cardiac services include cardiolite stress, adenoscan and adenowalk cardiolite imaging tests and spect imaging tests for accurate diagnosis, and monitored diet and exercise programs throughout the hospital stay and through outpatient care in our cardiac rehabilitation center.*3D Mammography: We have new 3D Mammography technology that detects cancer sooner than ever before*Emergency care: Our emergency center is staffed 24 hours a day throughout the year and handles everything from broken bones to heart attacks. *Home health services: Services provided to the home bound include nursing, physical, occupational, speech and social services.*Hospice: provide for the physical and psychological needs of the terminally ill and help accommodate their families through a full range of hospice services.*Nutritional counseling: Our registered dietitians provide nutritional assessments and personalized diet plans to optimize health and speed recovery through proper nutrition.*Physical and occupational therapy: Provide a full range of services to help patients recover from on-the-job, sports-related injuries and certain debilitating diseases.*Social services and support groups: Our facility provides a wide range of support in the coordination of services by our social service department and support groups to help our patients and their families cope with the emotional and financial effects of illness. *Podiatry services: Our licensed and credentialed doctor of podiatry medicine treats everything from flat feet to bunions with moderate therapeutic techniques.*Hearing services: We employ a licensed audiologist that can help correct hearing loss.*Surgery center: Our inpatient and outpatient surgery center is capable of handling a wide variety of general and specialized surgical procedures including laparoscopic and cataract procedures. *Other support services:-Laboratory, pathology and radiology services: Full range of services to provide accurate diagnosis for treatment -Care line: We operate an emergency response telephone based response center to enable the elderly to remain independent in their homes *Volunteers and volunteer services: We have, on the average, 99 community volunteers as follows:-Senior companions: Helping senior citizens maintain independence by reading to them, helping with shopping, etc. -Hospice: Assisting hospice patients and families cope with terminal illness -Children's TLC: Volunteers provide parents with a break with their children that are hospitalized -Telecare: Maintain contact with your friends or family member through telephone calls to their home -Gift Shoppe: Operated for the convenience of friends and family of hospital patients to obtain cards, flowers and small gifts for patients in our facility -Other services: Community members volunteer their services to help out in times of need in most service areas assisting patients and their families. | Desc |
| Total Program Service Expenses | $39,702,058 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 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 | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 53 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 416 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 | 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 | Yes (1) | 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 | Beverly Fiferlick | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7012521050 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2422 20th Street SW | AddressLine1Txt |
| City | Jamestown | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 584013360 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Connie Krapp | ||||||||
| Past Chairperson | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Dennis D Pozarnsky | ||||||||
| Chairperson | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Joanne H Ottmar | ||||||||
| Vice Chairperson | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Pat Nygaard | ||||||||
| Secretary/Treasurer | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Terry Anderson | ||||||||
| Sec/Treas (thru Nov 2015) | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Michael Dean MD | ||||||||
| Board Member/Orthopedic Surgeon | 40.00 | 0.00 | Yes (X) | $673,128 | $0 | $63,698 | ||
| Sarah Schatz MD | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Eric Monson | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Casey Henderson | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Myra Quanrud MD | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Wanda Vining-Alber | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Mark Anderson | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| KC DeBoer | ||||||||
| CEO | 40.00 | 1.00 | Yes (X) | $262,701 | $0 | $44,831 | ||
| Brandon Vaughan | ||||||||
| CFO (thru Jan 2016) | 40.00 | 1.00 | Yes (X) | $127,890 | $0 | $30,463 | ||
| Beverly Fiferlick | ||||||||
| CFO (as of Apr 2016) | 40.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Trisha Jungels | ||||||||
| CNO | 40.00 | 0.00 | Yes (X) | $116,245 | $0 | $19,110 | ||
| Ricki Ramlo | ||||||||
| COO | 40.00 | 0.00 | Yes (X) | $117,053 | $0 | $26,701 | ||
| Dr Manuel Harris | ||||||||
| Podiatrist | 40.00 | 0.00 | $207,692 | $0 | $50,525 | Yes (X) | ||
| Dr Philip Jystad | ||||||||
| ER Physician | 40.00 | 0.00 | $374,503 | $0 | $63,764 | Yes (X) | ||
| Dr Scott Goecke | ||||||||
| ER Physician | 40.00 | 0.00 | $352,485 | $0 | $33,723 | Yes (X) | ||
| James Metzger | ||||||||
| CRNA | 40.00 | 0.00 | $195,366 | $0 | $37,264 | Yes (X) | ||
| Lee Ellingson | ||||||||
| CRNA | 40.00 | 0.00 | $218,075 | $0 | $39,259 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,645,138 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $409,338 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 21 | 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 |
|---|---|---|---|---|---|
| Gary Wade | |||||
| 484 Snider Dr | Walla Walla | WA | 99362 | Radiologist | $900,815 |
| Huron Consulting Services LLC | |||||
| 550 W Van Buren St | Chicago | IL | 60607 | Healthcare Consulting | $822,855 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $48,788 | RelatedOrganizationsAmt |
| Government Grants | $15,824 | GovernmentGrantsAmt |
| Total Contributions | $64,612 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Net Patient Service Revenue | 621400 | $43,156,365 | $43,156,365 | |
| Cafeteria | 900099 | $270,419 | $270,419 | |
| Laundry Services | 812300 | $47,075 | $47,075 | |
| Auxiliary Revenue | 900099 | $44,116 | $44,116 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $594,604 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $594,604 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $44,112,579 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $350,844 | TotalRevenueColumnAmt |
| Exclusion | $350,844 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $41,194 | 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 | $41,194 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $41,194 | TotalRevenueColumnAmt |
| Exclusion | $41,194 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $456,322 | SecuritiesAmt |
| Other | $15,051 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $456,322 | SecuritiesAmt |
| Other | $15,051 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $471,373 | TotalRevenueColumnAmt |
| Exclusion | $471,373 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $56,930 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $50,025 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,905 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,905 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $45,047,507 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $44,072,409 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $47,075 | UnrelatedBusinessRevenueAmt |
| Exclusion | $863,411 | 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 | $50 | TotalAmt |
| Program Services | $50 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,471,573 | TotalAmt |
| Program Services | $752,778 | ProgramServicesAmt |
| Management And General | $718,795 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,956,106 | TotalAmt |
| Program Services | $13,915,475 | ProgramServicesAmt |
| Management And General | $1,040,631 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $977,929 | TotalAmt |
| Program Services | $918,292 | ProgramServicesAmt |
| Management And General | $59,637 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,827,426 | TotalAmt |
| Program Services | $2,571,576 | ProgramServicesAmt |
| Management And General | $255,850 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,029,499 | TotalAmt |
| Program Services | $917,715 | ProgramServicesAmt |
| Management And General | $111,784 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,895 | TotalAmt |
| Management And General | $56,895 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,275 | TotalAmt |
| Management And General | $65,275 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,937,417 | TotalAmt |
| Program Services | $4,798,602 | ProgramServicesAmt |
| Management And General | $1,138,815 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $182,710 | TotalAmt |
| Program Services | $55,737 | ProgramServicesAmt |
| Management And General | $126,973 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $699,719 | TotalAmt |
| Program Services | $471,604 | ProgramServicesAmt |
| Management And General | $228,115 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,385 | TotalAmt |
| Program Services | $12,385 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $982,794 | TotalAmt |
| Program Services | $966,154 | ProgramServicesAmt |
| Management And General | $16,640 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $197,911 | TotalAmt |
| Program Services | $136,968 | ProgramServicesAmt |
| Management And General | $60,943 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,513 | TotalAmt |
| Program Services | $63,506 | ProgramServicesAmt |
| Management And General | $22,007 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,999,025 | TotalAmt |
| Program Services | $1,999,025 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,471,839 | TotalAmt |
| Program Services | $4,471,839 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $173,887 | TotalAmt |
| Program Services | $54,898 | ProgramServicesAmt |
| Management And General | $118,989 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $4,858,985 | $4,849,939 | $9,046 |
| Lease and Rental | $1,218,764 | $1,218,764 | |
| Provision for Bad Debts | $1,165,396 | $1,165,396 | |
| Food | $241,192 | $241,192 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $313,206 | TotalAmt |
| Program Services | $120,163 | ProgramServicesAmt |
| Management And General | $193,043 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,925,496 | TotalAmt |
| Program Services | $39,702,058 | ProgramServicesAmt |
| Management And General | $4,223,438 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,285,902 | BOYAmt |
| EOY | $3,929,262 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,058,569 | BOYAmt |
| EOY | $5,592,933 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $498,623 | BOYAmt |
| EOY | $488,113 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $145,520 | BOYAmt |
| EOY | $178,163 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $64,099,114 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $22,186,635 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,002,469 | BOYAmt |
| EOY | $41,912,479 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,717,516 | BOYAmt |
| EOY | $18,372,056 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,661,063 | BOYAmt |
| EOY | $1,748,242 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,369,662 | BOYAmt |
| EOY | $72,221,248 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,919,883 | BOYAmt |
| EOY | $3,806,837 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $618,032 | BOYAmt |
| EOY | $611,577 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,945,021 | BOYAmt |
| EOY | $44,829,927 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,238,721 | BOYAmt |
| EOY | $2,064,965 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,721,657 | BOYAmt |
| EOY | $51,313,306 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,354,893 | BOYAmt |
| EOY | $20,476,628 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $293,112 | BOYAmt |
| EOY | $431,314 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,648,005 | BOYAmt |
| EOY | $20,907,942 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,369,662 | BOYAmt |
| EOY | $72,221,248 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,122,011 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$10,885 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $148,811 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $4,131 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,131 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The organization pays dues to various professional organizations. A portion of those dues are used towards lobbying expenses. These lobbying expenses go towards advocating for the organizations purpose and mission. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $20,070 | BeginningBalanceAmt |
| Additions During Year | $44,116 | AdditionsDuringYearAmt |
| Distributions During Year | $54,725 | DistributionsDuringYearAmt |
| Ending Balance | $9,461 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $433,429 | OtherCostOrOtherBasisAmt |
| Book Value | $433,429 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $46,083,796 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,270,626 | DepreciationAmt |
| Book Value | $34,813,170 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $789,268 | OtherCostOrOtherBasisAmt |
| Depreciation | $155,276 | DepreciationAmt |
| Book Value | $633,992 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,274,460 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,615,155 | DepreciationAmt |
| Book Value | $5,659,305 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $518,161 | OtherCostOrOtherBasisAmt |
| Depreciation | $145,578 | DepreciationAmt |
| Book Value | $372,583 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $41,912,479 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated Third-Party Settlements | Desc |
| Amt | $2,064,965 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,064,965 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $44,015,337 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$10,885 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$1,027,194 | OtherRevenueAmt |
| Revenue Not Reported | -$1,038,079 | RevenueNotReportedAmt |
| Revenue Subtotal | $45,053,416 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$5,909 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$5,909 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $45,047,507 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $42,755,400 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $50,025 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $50,025 | ExpensesNotReportedAmt |
| Expenses Subtotal | $42,705,375 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,220,121 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,220,121 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $43,925,496 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 1b: | There is an auxiliary which operates under the EIN of the Organization. |
| Part X, Line 2: | The Medical Center is organized as a North Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Medical Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Organization is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Organization files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. The Organization 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 consolidated financial statements. The Organization 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 Included in Revenue on Financial Statements -1,165,396. Increase in Interest in Foundation 138,202. |
| Part XI, Line 4b - Other Adjustments: | Cost of Goods Sold Included in Expenses on Financial Statements -50,025. Auxiliary Revenues 44,116. |
| Part XII, Line 2d - Other Adjustments: | Cost of Goods Sold Included in Expenses on Financial Statements 50,025. |
| Part XII, Line 4b - Other Adjustments: | Provision for Bad Debts Included in Revenue on Financial Statements 1,165,396. Auxiliary Expenses 54,725. |
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 |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $364,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $364,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00850 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,467,330 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,274,472 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $192,858 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00450 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,831,330 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,274,472 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $556,858 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01300 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,876 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $12,876 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,521,553 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,790,075 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,731,478 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04050 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,534,429 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,790,075 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,744,354 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04080 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,365,759 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,064,547 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,301,212 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05380 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,165,396 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $230,748 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $12,894,443 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $13,683,599 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$789,156 | 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 | Jamestown Regional Medical Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2422 20th St SW | AddressLine1Txt |
| City | Jamestown | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58401 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.jrmcnd.com | WebsiteAddressTxt |
| State License | 5027 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Lutheran Charity 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 |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 14 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.jrmcnd.com/about/community | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | http://centralvalleyhealth.org/HIP.html | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.jrmcnd.com/about/community/ | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| 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 | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://www.jrmcnd.com/resource-center/patient-accounts/community-care/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://www.jrmcnd.com/resource-center/patient-accounts/community-care/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://www.jrmcnd.com/resource-center/patient-accounts/community-care/ | 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 |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Lutheran Charity Association | Part V, Section B, Line 5: A public survey was conducted by the University of North Dakota Center for Rural Health (UND CRH) from February to March 2015. The survey was available in both paper and electronic versions; a variety of notices were provided to the general public. Approximately 300 surveys were completed. Analysis was provided by the UND CRH and results were shared at a community meeting in May 2015. Focus groups were also done in May - June 2015. |
| Lutheran Charity Association | Part V, Section B, Line 6a: Central Valley Health District and ND State Hospital |
| Lutheran Charity Association | Part V, Section B, Line 6b: The CHNA was conducted with Central Valley Health District. |
| Lutheran Charity Association | Part V, Section B, Line 11: Community members identified the following priority areas by using surveys and focus groups:* Physical Activity and Obesity: Enhance physical activity and obesity prevention efforts by monitoring progress at monthly Community Health Partnership meetings, increasing New Year New You participation by 10% each year, work with TRAC Executive Board to construct and open the TRAC.* Physical Environment - Not Enough Affordable Housing: Increase tenant-base rental assistance availability by working with HUD, USDA Rural Development, Federal and State officials, etc.* Access to Care - Cost and Adequacy of Health Insurance: Increase education and awareness of health choices and behaviors. * Employment - Workforce: Increase education and awareness of workforce challenges by engaging community partners to strengthen capacity.There were results accomplished in FYE16 on the priorities of the prior CHNA:Physical Activity and Obesity: * NYNY Results showed improvement in all 15 healthy lifestyle behaviors of which included:* Minimum exercise recommendation was reached by 41% pre-challenge and 63% post-challenge. 57% were aware of minimum number of minutes to accumulate of exercise weekly.* Average consumption of 3 or more servings of fruit increased from 36% pre-challenge to 74% post-challenge.* Average consumption of 3 or more servings of vegetables increased from 43% pre-challenge to 69% post-challenge.* Decrease from 68% to 53% for eating meals prepared outside the home each week.Improvement in the following self-reported areas:* How often do you feel overwhelmed or unable to cope with the pace of your life?57% responded Rarely or Never pre-challenge70% responded Rarely or Never post-challenge* Do you experience sleeplessness or interrupted sleep on a regular basis?48% responded Yes pre-challenge27% responded Yes post-challenge* Do you experience tension on a regular basis?39% responded Yes pre-challenge21% responded Yes post-challenge* How many hours of sleep do you average per night?69% received 7-9 hours pre-challenge90% received 7-9 hours post-challenge* 53% had a weight loss goal and 327 pounds were lost.* Busy work schedule (67%) and time demands of family members (49%) are the top obstacles to maintaining a healthier lifestyle.* Two Rivers Activity Center construction underway and is scheduled to open in 2017Physical Environment - Not Enough Affordable Housing:* In Jamestown, housing is up to a 4% vacancy rate from 2% (Spring 2016)Access to Care - Cost and Adequacy of Health Insurance: * JRMC providers/programs: - Urology (first time ever in the community) - No Excuses Campaign promotes breast health at no cost to the patient - a partnership with Central Valley Health and Women's Way sharps collection - SANE (sexual assault nurse examiner) services relocated to JRMC. In May three additional nurses trained as SANEs. SANE Coordinator hired. - Community Care - Health TracksEmployment - Workforce:* North Dakota Unemployment Rate 2.8% |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - JRMC Clinic | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2422 20th Street SW | AddressLine1Txt |
| City | Jamestown | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58401 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | Clinic | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | The patient may be asked to provide additional information to help determine eligibility for financial assistance that is not based upon the federal poverty guidelines. Items the patient is asked to also provide include:-Medical Assistance eligibility/denial notice if applicable-Income tax returns for the 2 most recently filed years-Proof of income and adjusted gross income such as pay stubs from the past 6 pay periods, W-2 withholding statements, Social Security checks, receipts, or deposits, and bank statements-Notification of Benefit decision from the ND Department of Human Services |
| Part I, Line 7: | Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. Health Professions education, line 7f, is reported based on actual expense amounts recorded in the general ledger. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. |
| Part I, Ln 7 Col(f): | The amount of bad debt expense removed from the denominator of the calculations was $1,165,396. |
| Part III, Line 2: | In evaluating the collectability of patient accounts receivable, the organization analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts specifically, for receivables associated with services provided to patients who have third-party coverage. The organization analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts for expected uncollectible amounts for which the third-party payer has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely for receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill). The organization records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. |
| Part III, Line 3: | We used charity care as a percent of gross revenue to estimate bad debt expense attributable to patients eligible under the FAP. |
| Part III, Line 4: | The footnote to the Organization's financial statements can be found on page 8 and 9 of the attached audited financial statements. |
| Part III, Line 8: | IRS Rev. Rul. 69-545, which established the community benefit standard for nonprofit hospitals, states that if a hospital serves patients with government health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community. In some communities, Medicare is the largest payer, and hospitals must accept these patients regardless of whether they make a surplus or deficit from providing such services. If the Medicare participation is premised on this fact, then providing Medicare services promotes access to healthcare services which is a community benefit. Also, the elderly are often an underserved population who experience issues with access to healthcare services. Without tax-exempt hospitals providing Medicare services, the government would bear the burden of directly providing services to the elderly. Medicare allowable costs are based on the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. |
| Part III, Line 9b: | No collections effort will be made by Jamestown Regional Medical Center or its collection agencies on the percentage of community care approved. However, patients must have completed the community care application process, establish their eligibility, and have been approved. Upon receipt of an incomplete application, the guarantor will have 30 days from notification of the incomplete application to complete the application thoroughly or the application will be void. Four billing statements will be sent to patients over the course of 120 days after the first statement is sent. The fourth statement will inform the patient of potential Extraordinary Collection Actions. |
| Part VI, Line 2: | The Community Health Partnership was formed in March 2013 after the completion of the 2012 Community Health Assessment and Community Health Improvement Plan. The Community Health Partnership is comprised of community members and numerous community agencies. The purpose of the Community Health Partnership is to provide effective, quality health and safety services in an environment that enables community members to reach their full potential through assessment, leadership and partnerships. The goals of the community health partnership are:-Enhance efficiency of community connections-Decrease duplication of efforts (and meetings)-Improve awareness and health within the community (Stutsman County)The organization also recently completed its 2nd Community Health Needs Assessment during the 6/30/15 fiscal year end. |
| Part VI, Line 3: | All patients receive a "Payment Guidelines" brochure at time of registration, which notifies the patients on how to apply for charity care as well as explains the claim filing process, responsible party, co-pays and payments. All private pay patients receive a letter which lists charity care as a payment alternative to those who qualify. Our website contains a charity care link which explains the program and allows forms to be downloaded and printed. |
| Part VI, Line 4: | Jamestown Regional Medical Center serves a nine county area of South Central North Dakota. The primary industry is agriculture. The population is 52,155 with 21% over the age of 65. The average age is 42. Male and female population is split evenly. Average income by household is $53,650. There are two colleges within Jamestown Regional Medical Center trade area. Jamestown Regional Medical Center is the only birthing center within a 90 mile radius. |
| Part VI, Line 5: | A majority of the Governing body is comprised of persons who reside in the organization's primary service area who are neither employees nor contractors of Jamestown Regional Medical Center, nor family members thereof. Jamestown Regional Medical Center extends medical staff privileges to all qualified physicians in the community. Jamestown Regional Medical Center recently moved into a new replacement hospital which has many upgrades in technology, most of which are related to improving patient care. Surplus funds, when available, are used to invest in both capital assets and medical equipment in order to improve patient care. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| 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 | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Michael Dean MD | ||||||||||||||
| Board Member/Orthopedic Surgeon | $672,747 | $0 | $0 | $0 | $381 | $0 | $44,042 | $0 | $20,222 | $0 | $737,392 | $0 | $0 | $0 |
| KC DeBoer | ||||||||||||||
| CEO | $262,340 | $0 | $0 | $0 | $361 | $0 | $23,205 | $0 | $22,512 | $0 | $308,418 | $0 | $0 | $0 |
| Brandon Vaughan | ||||||||||||||
| CFO (thru Jan 2016) | $127,832 | $0 | $0 | $0 | $58 | $0 | $11,448 | $0 | $19,536 | $0 | $158,874 | $0 | $0 | $0 |
| Dr Manuel Harris | ||||||||||||||
| Podiatrist | $206,175 | $0 | $0 | $0 | $1,517 | $0 | $17,694 | $0 | $33,397 | $0 | $258,783 | $0 | $0 | $0 |
| Dr Philip Jystad | ||||||||||||||
| ER Physician | $373,856 | $0 | $0 | $0 | $647 | $0 | $44,042 | $0 | $20,289 | $0 | $438,834 | $0 | $0 | $0 |
| Dr Scott Goecke | ||||||||||||||
| ER Physician | $352,124 | $0 | $0 | $0 | $361 | $0 | $26,042 | $0 | $8,247 | $0 | $386,774 | $0 | $0 | $0 |
| James Metzger | ||||||||||||||
| CRNA | $195,269 | $0 | $0 | $0 | $97 | $0 | $17,737 | $0 | $20,094 | $0 | $233,197 | $0 | $0 | $0 |
| Lee Ellingson | ||||||||||||||
| CRNA | $217,714 | $0 | $0 | $0 | $361 | $0 | $17,927 | $0 | $21,898 | $0 | $257,900 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 7 | FormAndLineReferenceDesc |
| Explanation | There is an incentive plan specifically for the CEO. This plan is designed to encourage, recognize and reward superior job and organizational performance. Incentive awards that may be paid under the terms of this plan are determined by overall organizational and individual performance for the annual operating period. The Chair of the Board of Directors has the responsibility to implement this plan. The incentives for the CEO are expressed as a percentage of the participant's base salary at the end of the incentive plan year. The maximum award is approved by the Board for each plan year. There is a detailed criterion for the results of what the organization considers a superior job. The criteria uses goal driven measures that intend to incentivize important long term strategic objectives over short term efforts only. The CEO's performance is measured based on the following areas of focus: Service, Quality, Financial, People, Growth, and Personal Growth. There is a ranking system for sets of criterion, and the Board of Directors is to utilize this system in determining the level of incentive the CEO will receive. For FY 2016, the incentive plan for the CEO was 6.7% of his base salary. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, line 2 | The JRMC Urology Clinic, which opened November 2015, specializes in treating urological diseases. The Organization began providing outside laundry services under a contract to the Anne Carlsen Center on January 1st, 2016. |
| Form 990, Part VI, Section A, line 1 | The Governance Committee consists of the officers of the Board of Directors. A majority of the members of the Governance Committee constitutes a quorum. The Governance Committee: A. Reviews the performance of the President/Chief Executive Officer of the Jamestown Regional Medical Center on the anniversary date of employment and report the findings to the Board of Directors. B. Assists our board to fulfill its responsibilities for ensuring high levels of governance performance and contribution. C. Assists our board to appoint and re-appoint directors; and formulating policies regarding making decisions about and overseeing governance effectiveness, efficiency, creativity and adaptability. D. Takes action on behalf of our board in emergency situations when we cannot be convened; emergency actions taken by the Governance Committee must be reported to the, and discussed/ratified by, our board at its next regularly scheduled meeting. |
| Form 990, Part VI, Section B, line 11 | The preparer of the Form 990 provides an electronic copy of the final 990 to the organization's Chief Financial Officer. The Chief Financial Officer performs a detailed review of Form 990. The Chief Financial Officer provides each voting Board Member with a copy of the Form 990 prior to submitting to the Internal Revenue Service. |
| Form 990, Part VI, Section B, line 12c | The conflict of interest policy covers employees and board members. The Compliance Officer reviews all potential conflicts and determines if a conflict exists. Directors are asked at every board meeting whether or not anyone has a duality of interest or conflict of interest. Directors having a duality of interest or a possible conflict of interest on any matter which comes before the board shall not vote on the matter or use their personal influence on the matter. The minutes of the meeting shall reflect that a disclosure of duality or conflict of interest was made, and the director making such a disclosure shall not be counted in declaring a quorum for the determination of the matter. This provision shall not be construed as preventing the director from briefly stating a position on the matter nor from answering pertinent questions. |
| Form 990, Part VI, Section B, line 15 | For the CEO, the Board Chairman converses with an HR consultant on market wages and evaluation process. Evaluation forms are typically completed by board members and the Board Chairman conducts the actual evaluation. Comparability data was used by those without conflict and the decisions were documented. This process takes place annually. The CFO is evaluated and compensated based on the Employee Performance Assessment policy that is standard for the organization. Comparability data is also used to determine adjustments to compensation. |
| Form 990, Part VI, Section C, line 19 | The organization does not make its governing documents, conflict of interest policy and financial statements available to the public. |
| Form 990, Part IX, line 11g | Consulting Services: Program service expenses 143,221. Management and general expenses 373,576. Fundraising expenses 0. Total expenses 516,797. Maintenance and Repair: Program service expenses 895,747. Management and general expenses 0. Fundraising expenses 0. Total expenses 895,747. Other Purchased Services: Program service expenses 3,759,634. Management and general expenses 217,675. Fundraising expenses 0. Total expenses 3,977,309. Contracted Services: Program service expenses 0. Management and general expenses 547,564. Fundraising expenses 0. Total expenses 547,564. |
| Form 990, Part XI, line 9: | Increase in Interest in the Foundation 138,202. Change in Auxiliary Net Assets 10,609. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jamestown Regional Medical Center Foundation Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2422 20th St SW | AddressLine1Txt |
| City | Jamestown | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58401 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363348763 | EIN |
| Primary Activities | Fundraising | PrimaryActivitiesTxt |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 11a, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Lutheran Charity Association | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Nierling Jamestown Hospital Trust | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2422 20th Street SW | AddressLine1Txt |
| City | Jamestown | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58401 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 912004888 | EIN |
| Primary Activities | Charitable Trust | PrimaryActivitiesTxt |
| Legal Domicile State | ND | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Lutheran Charity Association (DBA Jamestown Regional Medical Center) | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | T | EntityTypeTxt |
| Share Of Total Income | $2,629 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $85,489 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jamestown Regional Medical Center Foundation Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | Q | TransactionTypeTxt |
| Involved | $225,258 | InvolvedAmt |
| Method Of Amount Determination | cost | MethodOfAmountDeterminationTxt |