LIFECARE MEDICAL CENTER: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- LIFECARE MEDICAL CENTER (EIN 41-1804205)
- Tax period
- 2015-10-01 to 2016-09-30
- Filed
- 2017-07-05
- IRS object ID
- 201721869349300917
- 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 D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-07-05T09:53:25-05:00 | ReturnTs |
| Tax Period End | 2016-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Nicollet Mall Ste 1300 | AddressLine1Txt |
| City | Minneapolis | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554027033 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411804205 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LifeCare Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LIFE | BusinessNameControlTxt |
| Phone | 2184632500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 715 Delmore Drive | AddressLine1Txt |
| City | Roseau | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56751 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Keith Okeson | PersonNm |
| Person Title | CEO/President | PersonTitleTxt |
| Phone | 2184632500 | PhoneNum |
| Signature | 2017-06-27 | 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 | 2017-06-27 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Keith Okeson | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 715 Delmore Drive | AddressLine1Txt |
| City | Roseau | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56751 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $47,137,498 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.lifecaremedicalcenter.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1995 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | Promotion of Health | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 532 | TotalEmployeeCnt |
| Total Volunteers | 280 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $164,678 | PYContributionsGrantsAmt |
| CY Contributions Grants | $219,635 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $41,058,481 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $46,188,219 | CYProgramServiceRevenueAmt |
| PY Investment Income | $146,823 | PYInvestmentIncomeAmt |
| CY Investment Income | $402,019 | CYInvestmentIncomeAmt |
| PY Other Revenue | $88,828 | PYOtherRevenueAmt |
| CY Other Revenue | $115,925 | CYOtherRevenueAmt |
| PY Total Revenue | $41,458,810 | PYTotalRevenueAmt |
| CY Total Revenue | $46,925,798 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $20,209 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $185,258 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $21,958,067 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $23,462,378 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $17,186,873 | PYOtherExpensesAmt |
| CY Other Expenses | $18,099,798 | CYOtherExpensesAmt |
| PY Total Expenses | $39,165,149 | PYTotalExpensesAmt |
| CY Total Expenses | $41,747,434 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,293,661 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,178,364 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $63,679,113 | TotalAssetsBOYAmt |
| Total Assets EOY | $69,618,039 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,620,002 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,346,220 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $55,059,111 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $60,271,819 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | To provide care for a healthy life. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $35,670,579 | ExpenseAmt |
| Grant | $185,258 | GrantAmt |
| Revenue | $46,188,219 | RevenueAmt |
| Desc | LifeCare Medical Center operates a 25-bed acute care hospital, including a 50-bed nursing facility, home health, hospice, and public health in Roseau, Minnesota. The organization also operates a 40-bed nursing home and 12 apartments of assisted living in Greenbush, Minnesota. The purpose of the organization is to own, maintain, and operate a hospital, nursing homes, furnish medical and surgical care to the sick, infirmed, or injured.Acute Care Hospital (Inpatient and Outpatient)Inpatient days: 1,679Outpatient visits: 42,103Long Term CareLifeCare Roseau Manor Resident Days: 17,750LifeCare Greenbush Manor Resident Days: 14,198Home Health/Public Health Visits: 7,049Hospice Clients Served: 19To fulfill its mission of community service, LifeCare Medical Center provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. The amount of charges foregone, based on established rates, was $350,517 for the year ended September 30, 2016. | Desc |
| Total Program Service Expenses | $35,670,579 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 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 | 0 | 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 | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | 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 | 65 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 532 | 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 | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | 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 |
| 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 | Cathy Huss | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2184634763 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 715 Delmore Drive | AddressLine1Txt |
| City | Roseau | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56751 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 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 |
|---|---|---|---|---|---|---|---|
| Corwin Vatnsdal | |||||||
| Chair | 1.00 | Yes (X) | Yes (X) | $2,325 | $0 | $0 | |
| Brenda Sather | |||||||
| Vice Chair | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Mark Wilson | |||||||
| Secretary | 1.00 | Yes (X) | Yes (X) | $1,200 | $0 | $0 | |
| Therese McBride | |||||||
| Treasurer | 1.00 | Yes (X) | Yes (X) | $1,200 | $0 | $0 | |
| Paul Everson | |||||||
| Trustee (Oct-Aug) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Steve Haugen | |||||||
| Trustee (Oct) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Ralph Herseth MD | |||||||
| Trustee | 1.00 | Yes (X) | $1,350 | $0 | $0 | ||
| Chuck Lindner | |||||||
| Trustee | 1.00 | Yes (X) | $1,500 | $0 | $0 | ||
| Shayne Isane | |||||||
| Trustee | 1.00 | Yes (X) | $675 | $0 | $0 | ||
| Matthew Ulwelling | |||||||
| Trustee | 1.00 | Yes (X) | $900 | $0 | $0 | ||
| Beth Johnson | |||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Jessica Foss | |||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Dan Urness | |||||||
| Trustee (Aug-Sept) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Mark Karl | |||||||
| Trustee (Aug-Sept) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Keith Okeson | |||||||
| CEO/President | 40.00 | Yes (X) | $306,029 | $0 | $54,305 | ||
| Cathy Huss | |||||||
| CFO | 40.00 | Yes (X) | $199,643 | $0 | $43,240 | ||
| Gordon Streiff | |||||||
| Pharmacy Director | 40.00 | $153,641 | $0 | $41,860 | Yes (X) | ||
| Susan Lisell | |||||||
| Senior Leader | 40.00 | $171,080 | $0 | $24,076 | Yes (X) | ||
| Shannon D Carlson | |||||||
| Senior Leader | 40.00 | $141,728 | $0 | $38,790 | Yes (X) | ||
| Judy K Mattson | |||||||
| Pharmacist | 40.00 | $134,873 | $0 | $43,106 | Yes (X) | ||
| Kevin L Schumacher | |||||||
| Information Systems Direct | 40.00 | $123,850 | $0 | $32,854 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,239,994 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $278,231 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 19 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Comstock Construction Inc | |||||
| PO Box 396 | Fergus Falls | MN | 565380396 | Contractor/Construction | $2,495,260 |
| Wapiti Medical Group | |||||
| 107 Flynn Drive Suite 600 | Milbank | SD | 57252 | Locum Physician | $1,328,395 |
| Central Minnesota Diagnostic | |||||
| 150 10th St NW | Milaca | MN | 56353 | Imaging CT SCAN Service | $663,700 |
| R C Shefland Anesthesia Ltd | |||||
| 27040 County 9 | Bemidji | MN | 566019005 | Contracted Anesthesia Services | $507,388 |
| Connect Healthcare LLC | |||||
| 107 Flynn Drive Suite 600 | Milbank | SD | 57252 | Hospitalist Services | $309,840 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 31 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $122,154 | GovernmentGrantsAmt |
| All Other Contributions | $97,481 | AllOtherContributionsAmt |
| Total Contributions | $219,635 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net Patient Service Revenue | 622110 | $45,290,908 | $45,290,908 |
| Other Revenue | 621500 | $897,311 | $897,311 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $46,188,219 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $409,759 | TotalRevenueColumnAmt |
| Exclusion | $409,759 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $319,885 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $203,960 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $115,925 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $115,925 | TotalRevenueColumnAmt |
| Exclusion | $115,925 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $7,740 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$7,740 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$7,740 | TotalRevenueColumnAmt |
| Exclusion | -$7,740 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $46,925,798 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $46,188,219 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $517,944 | 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 | $181,258 | TotalAmt |
| Program Services | $181,258 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,000 | TotalAmt |
| Program Services | $4,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $641,974 | TotalAmt |
| Management And General | $641,974 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,921,052 | TotalAmt |
| Program Services | $15,355,149 | ProgramServicesAmt |
| Management And General | $2,565,903 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $587,394 | TotalAmt |
| Program Services | $503,292 | ProgramServicesAmt |
| Management And General | $84,102 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,992,152 | TotalAmt |
| Program Services | $2,563,741 | ProgramServicesAmt |
| Management And General | $428,411 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,319,806 | TotalAmt |
| Program Services | $1,097,054 | ProgramServicesAmt |
| Management And General | $222,752 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,801 | TotalAmt |
| Management And General | $41,801 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,248 | TotalAmt |
| Management And General | $56,248 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,921,527 | TotalAmt |
| Program Services | $4,505,176 | ProgramServicesAmt |
| Management And General | $416,351 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $151,181 | TotalAmt |
| Program Services | $49 | ProgramServicesAmt |
| Management And General | $151,132 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,383,778 | TotalAmt |
| Program Services | $867,019 | ProgramServicesAmt |
| Management And General | $516,759 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5 | TotalAmt |
| Management And General | $5 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $916,062 | TotalAmt |
| Program Services | $907,917 | ProgramServicesAmt |
| Management And General | $8,145 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $321,165 | TotalAmt |
| Program Services | $275,408 | ProgramServicesAmt |
| Management And General | $45,757 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,029 | TotalAmt |
| Program Services | $9,836 | ProgramServicesAmt |
| Management And General | $38,193 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,552 | TotalAmt |
| Program Services | $97,552 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,662,061 | TotalAmt |
| Program Services | $2,662,061 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $162,183 | TotalAmt |
| Program Services | $162,183 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Medical Supplies | $4,496,200 | $4,496,200 |
| Surcharge Fees | $530,414 | $530,414 |
| Bad Debt Expense | $506,476 | $506,476 |
| MN Care Tax | $417,151 | $417,151 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,387,965 | TotalAmt |
| Program Services | $528,643 | ProgramServicesAmt |
| Management And General | $859,322 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,747,434 | TotalAmt |
| Program Services | $35,670,579 | ProgramServicesAmt |
| Management And General | $6,076,855 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,669,216 | BOYAmt |
| EOY | $4,586,497 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,484,036 | BOYAmt |
| EOY | $6,252,142 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $763,393 | BOYAmt |
| EOY | $926,426 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $203,863 | BOYAmt |
| EOY | $219,713 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $53,346,325 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $27,124,449 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,833,723 | BOYAmt |
| EOY | $26,221,876 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,981,445 | BOYAmt |
| EOY | $30,804,292 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $527,928 | BOYAmt |
| EOY | $508,127 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $215,509 | BOYAmt |
| EOY | $98,966 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,679,113 | BOYAmt |
| EOY | $69,618,039 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,937,355 | BOYAmt |
| EOY | $4,672,564 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,445,000 | BOYAmt |
| EOY | $3,935,000 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $237,647 | BOYAmt |
| EOY | $259,545 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $479,111 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,620,002 | BOYAmt |
| EOY | $9,346,220 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,059,111 | BOYAmt |
| EOY | $60,271,819 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,059,111 | BOYAmt |
| EOY | $60,271,819 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,679,113 | BOYAmt |
| EOY | $69,618,039 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $5,178,364 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $34,344 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,740 | OtherCostOrOtherBasisAmt |
| Book Value | $7,740 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $37,200,882 | OtherCostOrOtherBasisAmt |
| Depreciation | $16,996,240 | DepreciationAmt |
| Book Value | $20,204,642 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,578,735 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,624,506 | DepreciationAmt |
| Book Value | $3,954,229 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,558,968 | OtherCostOrOtherBasisAmt |
| Depreciation | $503,703 | DepreciationAmt |
| Book Value | $2,055,265 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $26,221,876 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated Third-Party Payor Settlements | Desc |
| Amt | $479,111 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $479,111 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $46,477,329 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $34,344 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$686,773 | OtherRevenueAmt |
| Revenue Not Reported | -$652,429 | RevenueNotReportedAmt |
| Revenue Subtotal | $47,129,758 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$203,960 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$203,960 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $46,925,798 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $41,264,621 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $203,960 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $203,960 | ExpensesNotReportedAmt |
| Expenses Subtotal | $41,060,661 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $686,773 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $686,773 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $41,747,434 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 2b: | The Medical Center acts as custodian for the funds of the residents, holds resident security deposits, and holds employee voluntary withholdings. Funds for residents and others totaled $259,545 and $237,647 at September 30, 2016 and 2015. |
| Part X, Line 2: | The Medical Center is organized as a Minnesota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Medical Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Medical Center is subject to income tax on net income that is derived from business activities that are unrelated to their exempt purpose. The Medical Center files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. The Medical Center believes that is has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Medical Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
| Part XI, Line 2d - Other Adjustments: | Provision for Bad Debts Recorded in Revenue for Financial Statements -506,476. Grant Expense Recorded in Revenue for Financial Statements -180,297. |
| Part XI, Line 4b - Other Adjustments: | Rental Expense Recorded in Expense for Financial Statements -203,960. |
| Part XII, Line 2d - Other Adjustments: | Rental Expense Recorded in Expense for Financial Statements 203,960. |
| Part XII, Line 4b - Other Adjustments: | Provision for Bad Debts Recorded in Revenue for Financial Statements 506,476. Grant Expense Recorded in Revenue for Financial Statements 180,297. |
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 |
| Percent200 | Yes (X) | Percent200Ind |
| 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 | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $215,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $215,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00520 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,988,522 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,208,639 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $779,883 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01890 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,203,522 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,208,639 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $994,883 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02410 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $242,537 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,800 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $235,737 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00570 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $201,915 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $201,915 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00490 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,350,201 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,776,389 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,573,812 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03820 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $128 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $128 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $348,462 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $110,539 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $237,923 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00580 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,143,243 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,893,728 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,249,515 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05460 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,346,765 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,102,367 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,244,398 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07870 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,188 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,188 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $52,551 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $52,551 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,165 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $15,165 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,100 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $20,100 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $106,835 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $100,835 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00240 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $43,711 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $43,711 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $241,550 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,000 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $235,550 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00580 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $506,476 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $3,076 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $8,445,842 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,538,019 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$92,177 | 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 | LifeCare Medical Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 715 Delmore Drive | AddressLine1Txt |
| City | Roseau | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56751 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.lifecaremedicalcenter.org | WebsiteAddressTxt |
| State License | 00579 | 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 |
| Emergency Room Other | Yes (X) | EmergencyRoomOtherInd |
| Other | Urgent Care | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LifeCare Medical Center | 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.lifecaremedicalcenter.org/about | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.lifecaremedicalcenter.org/about | 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 | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://lifecaremedicalcenter.org/financialassist/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://lifecaremedicalcenter.org/financialassist/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://lifecaremedicalcenter.org/financialassist/ | 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 |
| 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 |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| LifeCare Medical Center | Part V, Section B, Line 5: Representatives from both LifeCare Medical Center and LifeCare Public Health conducted meetings with organizations and individuals who represent all geographic and age levels in our service area. These included: Roseau Ministerial Association, Warroad School District, Roseau School District, Badger/Greenbush School District, Roseau County Court system, Warroad Chamber of Commerce, Altru Physicians, Marvin Windows and Doors, Central Boiler and Polaris Industries (3 largest employers in service area). In addition, those who serve low-income and minority populations were represented by Roseau County Social Services, LifeCare Public Health, Northwest Community Action and HeadStart. |
| LifeCare Medical Center | Part V, Section B, Line 6b: LifeCare Public Health (public health agency for Roseau County). |
| LifeCare Medical Center | Part V, Section B, Line 7d: The CHNA was mailed to all city offices, county leadership and those who participated in the needs assessment. |
| LifeCare Medical Center | Part V, Section B, Line 11: LifeCare Medical Center's response to Community Health Needs identified in the most recent Community Health Needs Assessment for the most current tax period is as follows. There was not sufficient time to address the needs identified below from the 2015 CHNA due to timing of the approval of the implementation strategy with the year end:Mental Health -We will create community awareness of mental health issues and available resources.-We will create first point of access of mental health services.-We will establish roadmap/logistics on coordinating care of mental health patients.-We will develop care plans for individuals with identified mental health needs.Drug Abuse and Alcohol Abuse-Working with Roseau County on a 5 year grant, Drug-Free Communities Grant awarded by the US Department of Health and Human Services, LifeCare will work with the youth of Roseau County to decrease the use of alcohol and drugs.Obesity-We will host 24-hour on-site wellness centers in Roseau, Warroad and Greenbush.-Trained staff are available for health fairs at local employers and community events to provide nutrition and exercise related topics.-Matter of Balance classes are available in each community to enable older adults to remain active.-LifeCare will continue to partner with the Roseau Diabetes Center to provide the I Can Prevent Diabetes class.-Community trail maps with exercise and fitness trails will be made available.-Working in partnership with the City of Roseau Parks and Recreation will apply for a grant to provide fitness stations along the newly built walking trail.Health Parenting-Offers Prenatal classes and in-home well-baby checkup.-Expanding our partnership with the SAFE KIDS Coalition of Grand Forks to increase resources for the safety of children from birth to high school. -The Drug-Free Communities Grant, mentioned above, will include resources on positive parenting.Tobacco Use-Roseau County Fair Board has initiated changes to provide a smoke-free fairgrounds.-Working with Roseau county commissioners regarding stricter tobacco ordinances.-LifeCare continues to maintain 2 Freedom from Smoking facilitators and provides multiple sessions of this class in the different communities. |
| LifeCare Medical Center | Part V, Section B, Line 16i: In addition to providing the full policy upon request, the Hospital also summarizes the policy on its website, billing invoices, as well as brochures summarizing the policy in the emergency rooms and admissions office. |
| LifeCare Medical Center | Part V, Section B, Line 22d: The Medical Center uses the Lookback Method to calculate the amounts generally billed. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - LifeCare Roseau Manor | ||||
| 715 Delmore Drive | Roseau | MN | 56751 | Skilled Nursing Facility |
| 2 - LifeCare Greenbush Manor | ||||
| 19120 290th Street | Greenbush | MN | 56726 | Skilled Nursing Facility and Assisted Living Facility |
| 3 - LifeCare Home Care and Hospice | ||||
| 715 Delmore Drive | Roseau | MN | 56751 | Home Health and Hospice |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | Charity care was converted to cost by multiplying the ratio of cost to gross charges by the gross uncompensated charges associated with providing charity care to its patients. Community health improvements and cash and in-kind contributions are calculated at actual costs recorded in the general ledger. Education costs are based on estimated time and wages to manage students and interns at the facilities. Medicaid is calculated based on gross charges and estimated payments from the internal revenue system. Subsidized health services is converted to cost 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 total expenses to determine the percentage was $506,476. |
| Part II, Community Building Activities: | Economic development and community support includes donations to local community organizations and employee staff time donated to local community committees. Community support includes employee staff time spent on disaster preparedness beyond legal requirements.Environmental improvements include the time employees have been involved in a Healing Garden Team that has developed a tranquil park area for use by our patients, families, employees and community. We also had an asbestos removal project.Coalition building includes EMT and CPR training for area First Responders and Fire Departments, as well as time donated to the Roseau Area Diabetes Center.Community health improvement advocacy includes staff time on healthcare related boards that advocate for healthcare, as well as time spent on discussions on proper prescription drug disposals, med alerts, chronic disease management, time spent in local correctional facilities on prescription drug abuse and on the Roseau County Committee on Aging. By being involved in the community through the above activities, we are able to increase health awareness.Roseau County is considered a Health Professional Shortage Area and therefore is including the costs of recruitment in workforce development. This promotes better care for our patients. The costs include physician recruitment, career fairs and workforce development committees. |
| Part III, Line 2: | Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year. |
| Part III, Line 3: | The estimated amount of bad debt expense attributable to patients eligible under the organization's charity care policy is calculated by using gross charity care at charges as a percentage of total gross hospital revenue. It is reasonable to assume that charity care as a percentage of gross revenue can also be applied to bad debt. |
| Part III, Line 4: | The footnote to the organization's financial statements that describes bad debt expense can be found on page seven and eight of the audited financial statement. |
| Part III, Line 8: | Services are provided to patients under the Medicare program knowing that not all costs associated with providing these services will be recovered. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the entire Medicare shortfall is considered a community benefit.Medicare allowable costs of care 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: | If a patient is known to qualify for financial assistance, or if the patient begins the financial assistance process, all collection actions cease until the application is completed. |
| Part VI, Line 2: | LifeCare provides the Public Health functions for Roseau County. Through this role, we participated in a community needs assessment through Quinn County to assess the needs of our service area. |
| Part VI, Line 3: | We have financial counselors who have phone conversations with patients during our collections process. We guide patients to other financial programs as well as our own charity care program. Brochures are available in the admitting area which is in the same location as the Emergency Room. Information is also sent to our patients via patient bills. Our website has the charity care application and brochure, as well as the contact information for our financial counselors, available to patients. |
| Part VI, Line 4: | Roseau County is a rural area with a population of approximately 17,000 people. We are the sole hospital located in Roseau County and the nearest tertiary hospital is two hours away. We are a federally-designated medically underserved area. In 2009, approximately 12.7% of the population was age 65 or older. The average per capita income is 23,061 and approximately 9.7% of the population is below the federal poverty level. |
| Part VI, Line 5: | The organization's governing body is comprised of volunteer members who reside in the community. Medical staff privileges are extended to all qualified physicians in the community. Surplus funds are reinvested in facilities to improve patient care. The hospital operates an emergency room that is available to all, regardless of ability to pay.As a not-for-profit organization, LifeCare Medical Center has made a promise to give back to its community. As a regional healthcare leader, LifeCare strives to respond to healthcare needs by partnering with local leaders, educators, government officials and others.The community benefit report summarizes how this leadership role has made a difference to the people of the area. Included are highlights describing how LifeCare has played an integral role in enhancing the health and overall well-being of the community.Trusted PartnershipsLifeCare's commitment to quality care extends beyond its walls and into the community where strong partnerships have been built to maintain and improve the health and overall well-being of its neighbors. LifeCare EMS personnel are proud of their trusted relationships with regional emergency response groups. Area fire fighters, police, and others participate in disaster training sessions where a disaster is staged and responded to as if it were a real life situation. This type of training helps prepare all groups involved.Education for a Healthy FuturePart of LifeCare's mission is to help educate the next generation of health care professionals. LifeCare Directors work closely with many regional high school and post-secondary educational facilities to bring students into our organization through job shadowing, internships, rural scholar and other programs. Through these programs, students get a firsthand look at specific health care careers as they learn from our staff for a day, week, month or several months based on their program. Students often times focus on rural healthcare employment opportunities that may be available to them once they have completed their education.Community CareLifeCare recognizes that circumstances arise where a patient is simply unable to pay a hospital bill. In these situations, LifeCare offers a program called Community Care, in which LifeCare forgives the bills of deserving families and individuals who meet set income guidelines. Great appreciation has been voiced by many who received a helping hand from this program. In fiscal year 2016, LifeCare granted over $350,000 in Community Care based on charges foregone.A Healthy Awareness and Community OutreachLifeCare employees know the importance of educating the public about a healthy lifestyle. And sometimes the best way to provide awareness is to venture outside the facility. That's why LifeCare is involved with many initiatives throughout our communities. By reaching out to the public through parish nursing, nutrition and exercise programs, civic projects, health and safety awareness, health fairs, and other methods, they are able to educate and strengthen the community.Fifth grade tours have become a favorite for students throughout Roseau County. A hospital tour is coupled with a mini health fair where students learn their blood type. The goal of this program is to influence young students into making healthy lifestyle decisions, in addition to introducing them to careers in healthcare.Funding Essential ServicesLifeCare's commitment to community needs is exemplified by its contribution to subsidized services. In fiscal year 2016, LifeCare absorbed over $2,400,000 in costs in order to sustain services that rely on funding from other sources, in particular the Medicaid program. These departments include Home Health Care, Public Health, Ambulance, Clinic space and LifeCare's two nursing homes (Roseau Manor and Greenbush Manor).LifeCare Medical Center distributed nearly $4.2 million in Community Benefits in fiscal year 2016. |
| Part VI, Line 7, Reports Filed With States | MN |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| Roseau County | |||||||
| 606 5th Ave SW | Roseau | MN | 56751 | 416005889 | Roseau County | $31,258 | Valley Med Flight: pay for half of the expense to cover all costs not paid by insurance for each person that lives in Roseau County that needs to take a flight to another hospital. |
| City of Roseau | |||||||
| 121 Center St E 202 | Roseau | MN | 56751 | 416005499 | Roseau | $50,000 | Parks and Recreation Dept - Water park fundraising |
| Sunshine Memorial Foundation | |||||||
| 4200 James Ray Drive | Grand Forks | ND | 58203 | 460731709 | 501(c)(3) | $100,000 | Patient housing project building in Grand Forks |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 3 | 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 Medical Center does not monitor the use of funds. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Keith Okeson | ||||||||||||||
| CEO/President | $273,345 | $0 | $31,050 | $0 | $1,634 | $0 | $20,329 | $0 | $35,745 | $0 | $362,103 | $0 | $0 | $0 |
| Cathy Huss | ||||||||||||||
| CFO | $186,878 | $0 | $11,050 | $0 | $1,715 | $0 | $13,105 | $0 | $31,795 | $0 | $244,543 | $0 | $0 | $0 |
| Gordon Streiff | ||||||||||||||
| Pharmacy Director | $151,760 | $0 | $550 | $0 | $1,331 | $0 | $10,493 | $0 | $32,834 | $0 | $196,968 | $0 | $0 | $0 |
| Susan Lisell | ||||||||||||||
| Senior Leader | $165,923 | $0 | $1,050 | $0 | $4,107 | $0 | $11,061 | $0 | $14,522 | $0 | $196,663 | $0 | $0 | $0 |
| Shannon D Carlson | ||||||||||||||
| Senior Leader | $139,490 | $0 | $1,000 | $0 | $1,238 | $0 | $9,265 | $0 | $30,899 | $0 | $181,892 | $0 | $0 | $0 |
| Judy K Mattson | ||||||||||||||
| Pharmacist | $133,363 | $0 | $250 | $0 | $1,260 | $0 | $9,131 | $0 | $35,088 | $0 | $179,092 | $0 | $0 | $0 |
| Kevin L Schumacher | ||||||||||||||
| Information Systems Direct | $122,370 | $0 | $500 | $0 | $980 | $0 | $7,649 | $0 | $26,396 | $0 | $157,895 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Roseau Area Hospital District | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 410785143 | BondIssuerEIN |
| CUSIP | 777187CW3 | CUSIPNum |
| Bond Issued | 2012-11-15 | BondIssuedDt |
| Issue Price | $5,860,000 | IssuePriceAmt |
| Purpose | Refund Series 1998 Bonds Issued 12/01/1998 | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $1,925,000 | RetiredAmt |
| Total Proceeds | $5,860,000 | TotalProceedsAmt |
| In Reserve Fund | $586,000 | InReserveFundAmt |
| Issuance Costs From Proceeds | $117,200 | IssuanceCostsFromProceedsAmt |
| Other Spent Proceeds | $5,156,800 | OtherSpentProceedsAmt |
| Substantial Completion | 2012 | SubstantialCompletionYr |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule K, Part II, Line 4, Gross Proceeds in Reserve Fund | FormAndLineReferenceDesc |
| Explanation | The filing organization does not report the $586,000 reserve funds on their audited financials due to the issuer of the tax exempt bonds holding these funds. The issuer of the tax exempt bonds has included this amount on their financial statements. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | The Executive Committee consists of the Chair, Vice-Chair, Treasurer, Secretary, and at least one other director (who shall be selected annually.) The President/CEO will be a non-voting member of the committee. The President/CEO will be excused for matters relating to compensation and evaluation. The Executive Committee shall meet as often as necessary at the call of the Chair, Vice-Chair, or at the request of any two of its members. A majority of the Executive Committee shall constitute a quorum. The Executive Committee's specific responsibilities are to: * Exercise the authority of the board in the management of the business of the corporation between regularly scheduled meetings. * Report to the board any official actions it has taken at the next board meeting. * Review and approve the compensation program for the senior leaders of the organization that is designed to allow the organization to recruit and retain superior talent. * Responsible for conducting on an annual basis the process of establishing goals, evaluating the performance and establishing the compensation of the President/CEO. |
| Form 990, Part VI, Section B, line 11 | The return is reviewed initially by the CFO. The return is made available to the Board of Trustees before it is filed. |
| Form 990, Part VI, Section B, line 12c | All officers, trustees, and key employees are required to complete a conflict of interest form annually. The form is reviewed by the Board of Trustees to determine if any conflicts exist. If there are any conflicts, the Board of Trustees will discuss the restrictions that should be placed on the person with the conflict. Restrictions are typically related to voting and discussion of matters related to the conflict. |
| Form 990, Part VI, Section B, line 15 | The compensation for the CEO and CFO is approved by the Executive Committee based on comparability data. The CEO and CFO both have employment contracts. The deliberation and discussion of compensation is documented in the board meeting minutes. This process takes place on an annual basis. |
| Form 990, Part VI, Section C, line 19 | The organization's governing documents, conflict of interest policy, and financial statements are available upon request. |
| Form 990, Part IX, line 11g | Physician Fees: Program service expenses 1,793,462. Management and general expenses 18,500. Fundraising expenses 0. Total expenses 1,811,962. Service Related Fees: Program service expenses 2,525,652. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,525,652. Other Professional Fees: Program service expenses 186,062. Management and general expenses 397,851. Fundraising expenses 0. Total expenses 583,913. |