2014-01-31T08:29:40-06:00 2013-06-30 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2012-07-01 450408291 Richardton Health Center Inc RICH 7019743304 PO Box H Richardton ND 586520908 Magan Pritzl 7019743304 2014-01-21 1 Lisa Chaffee P00193453 7012398500 2014-01-21 2012 2015-11-30 17:44:51Z Magan Pritzl PO Box H Richardton ND 586520908 2311246 0 X N/A X 1969 ND To create & help customers by providing the very best care to people in our facility & community. 9 8 71 15 0 0 573823 439362 1582541 1855294 312 -7202 37943 16576 2194619 2304030 574 904 0 0 955817 1191919 0 0 0 1079412 941932 2035803 2134755 158816 169275 1563712 1653748 506383 427609 1057329 1226139 To create and help customers by providing the very best care to the people in our facility and community. 0 0 1870079 904 1855294 Richardton Health Center provides high quality clinic healthcare and skilled nursing care services to Richardton and the surrounding area. This includes respite care, acute inpatient care, cardiac rehab, PT, OT, ST, a free standing rural health clinic and long-term care facilities. 1870079 1 1 0 0 0 0 0 0 1 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 13 0 1 71 1 0 0 0 0 0 0 0 0 0 0 X 9 8 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X Magan Pritzl 7019743304 PO Box H Richardton ND 58652 X Claire Messmer 1.00 X X 0 0 0 Jerome Messer 1.00 X X 0 0 0 Vickie Solemsaas 1.00 X X 0 0 0 Donna Reich 1.00 X X 0 0 0 Roberta Fandrich 0.50 X 0 0 0 Kathy Hueske 0.50 X 0 0 0 Michael Taffe OSB 0.50 X 0 0 0 Steve Maershbecker 0.50 X 0 0 0 Andy Campbell 0.50 X 0 0 0 Magan Pritzl 40.00 X 0 0 0 Gerry Leadbetter 40.00 X 0 0 0 0 0 0 0 0 0 0 Dakota Travel Nurse Inc 502 West Main Street Mandan ND 58554 Contracted Nursing 172450 1 281962 157400 439362 Patient Service Revenu 621400 1846347 1846347 Other Revenue 900099 6807 6807 Auxiliary Revenue 900099 2140 2140 1855294 14 14 7216 -7216 -7216 -7216 Gain on Debt Forgivene 900099 16576 16576 16576 2304030 1855294 0 9374 X 904 904 1023361 907288 116073 83658 83658 84900 75272 9628 108765 108765 2192 2192 23500 23500 290840 290840 10738 10738 100628 106848 -6220 6994 6994 61512 61512 19336 19336 16267 16267 6215 6215 121440 121440 21376 21376 Medical Supplies 115791 115791 Dues/Subscriptions 3163 3163 Auxiliary Expense 1675 1675 31500 31500 2134755 1870079 264676 0 111004 74160 119720 155813 25189 30046 6369 12159 2584226 1422656 1101430 1161570 200000 220000 1563712 1653748 348760 296051 1187 2420 156436 129138 506383 427609 X 1057329 1226139 1057329 1226139 1563712 1653748 X 169275 -465 X 0 1 X 1 0 X 1021354 535920 305804 573823 439362 2876263 1965233 1520386 1740279 1582541 1853154 8661593 2986587 2056306 2046083 2156364 2292516 11537856 0 351107 926099 903580 875862 3056648 351107 926099 903580 875862 3056648 8481208 718 370 334 117 14 1553 718 370 334 117 14 1553 204640 36000 16576 257216 2987305 2261316 2046417 2192481 2309106 11796625 0.71900 0.78940 0.00010 0.00040 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 2787 2140 1675 3252 1 X 1743785 839562 904223 699487 535795 163692 140954 47299 93655 1161570 Bed Licenses 220000 220000 X 2301890 0 2301890 2140 2140 2304030 2133080 0 2133080 1675 1675 2134755 Part IV, Line 1b: Richardton Health Center Auxiliary is operating under the EIN of Richardton Health Center, however, the financial statements are not included in the audited financial statements of Richardton Health Center. Part IV, Line 2b: Richardton Health Center acts as custodian for the funds of the nursing facility residents. These funds are included in cash and accounts payable in the financial statements. Resident trust funds totaled $2,420 at June 30, 2013. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The Health Center is organized as a North Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Health Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Health Center is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Health Center has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Health Center believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Health Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 4b - Other Adjustments: Auxiliary Revenue 2,140. Part XII, Line 4b - Other Adjustments: Auxiliary Expenses 1,675. Laura Leingang Sister of Donna Reich (Board Member) 32337 Compensation & benefits 0 Form 990, Part VI, Section A, line 3 The Health Center has engaged Health Management Services (HMS) to provide management and administrative services. Administrative and management services include administrator compensation, along with other management and support service fees. Expenses recognized in relation to this agreement for Part VII, Administrator Compensation, totaled $84,722 for the year ended June 30, 2013. Form 990, Part VI, Section A, line 8b There are no committees that can act on behalf of the governing board. Form 990, Part VI, Section B, line 11 The Administrator and Board of Directors reviewed the Form 990 prior to the filing of the return. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers the board, employees and contractors alike. The Administrator reviews and determines if conflicts exist with employees and contractors. The board reviews and determines if conflicts exist with a board member. The board is responsible for monitoring its members and the board in regards to this policy. If needed, they will seek legal consultation. If a conflict is determined that individual will abstain from voting. In December 2011 the Organization contracted an unrelated management company, HMS, to provide the Administrator management services. HMS set the Administrator compensation based on comparability data. The Board reviews and approves the contract with HMS. Form 990, Part VI, Section C, line 19 The governing documents and conflict of interest policy are available to the public upon request. Other Fees Form 990, Part IX, line 11g Medical Professional Fees: Program service expenses 225,546. Management and general expenses 0. Fundraising expenses 0. Total expenses 225,546. Maintenance Fees: Program service expenses 6,081. Management and general expenses 0. Fundraising expenses 0. Total expenses 6,081. Other Miscellaneous Fees: Program service expenses 59,213. Management and general expenses 0. Fundraising expenses 0. Total expenses 59,213. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Change in Auxiliary Assets -465.