LUTHERAN CHARITY ASSOCIATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- LUTHERAN CHARITY ASSOCIATION (EIN 45-0231181)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-02-05
- IRS object ID
- 201430369349300608
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- 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) |
|---|---|---|
| Timestamp | 2014-02-05T09:34:29-06:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390758449 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7601 FRANCE AVENUE SOUTH SUITE 400 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55435 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450231181 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LUTHERAN CHARITY ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | LUTH | NameControl |
| Phone | 7012521050 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2422 20TH STREET SW | AddressLine1 |
| City | JAMESTOWN | City |
| State | ND | State |
| ZIP Code | 584013360 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BRANDON VAUGHAN | Name |
| Title | CHIEF FINANCIAL OFFICER | Title |
| Phone | 7012521050 | Phone |
| Date Signed | 2014-01-23 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TIM A RITTER CPA | Name |
| PTIN | P00732856 | PTIN |
| Phone | 9525483400 | Phone |
| Date Prepared | 2014-01-23 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAMESTOWN REGIONAL MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | BRANDON VAUGHAN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2422 20TH STREET SW | AddressLine1 |
| City | JAMESTOWN | City |
| State | ND | State |
| ZIP Code | 584013360 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 37325979 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.JRMCND.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1927 | YearFormation |
| State Legal Domicile | ND | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 421 | TotalNbrEmployees |
| Total Nbr Volunteers | 96 | TotalNbrVolunteers |
| Total Gross UBI | 267891 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1248424 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 87942 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 33842417 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 37017191 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -3379352 | InvestmentIncomePriorYear |
| Investment Income Current Year | 353459 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 16090 | OtherRevenuePriorYear |
| Other Revenue Current Year | -133843 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 31727579 | TotalRevenuePriorYear |
| Total Revenue Current Year | 37324749 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 17774868 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 18629167 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 18100679 | OtherExpensePriorYear |
| Other Expenses Current Year | 19554904 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 35875547 | TotalExpensesPriorYear |
| Total Expenses Current Year | 38184071 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -4147968 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -859322 | RevenuesLessExpensesCY |
| Total Assets BOY | 72928174 | TotalAssetsBOY |
| Total Assets EOY | 70952952 | TotalAssetsEOY |
| Total Liabilities BOY | 50820757 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 49567877 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 22107417 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 21385075 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | EXCEED EXPECTATIONS AND BE THE DIFFERENCE IN THE LIVES OF THOSE WE SERVE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 33478199 | Expense |
| Revenue | 37017441 | Revenue |
| Description | 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 THEN 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. WE ALSO PROVIDE SPACE FOR A SATELLITE DIALYSIS UNIT OPERATED BY SANFORD, 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, 2013:*4,936 INPATIENT DAYS OF WHICH 430 WERE SWING BED AND 25 HOSPICE DAYS OF CARE* 45.1% MEDICARE IS THE PERCENTAGE OF INPATIENT DAYS* 13.9% MEDICAID IS THE PERCENTAGE OF INPATIENT DAYS* 8,486 EMERGENCY VISITS OF WHICH 792 RESULTED IN INPATIENT ADMISSIONS* 28,613 TOTAL OUTPATIENT VISITS* 2,521 OUTPATIENT SURGICAL PROCEDURE VISITS INCLUDING OUTPATIENT SURGERY AND SCOPES* 359 LIVE BIRTHS* 2,723 ORTHOPEDIC PATIENTS* 2,013 CARDIAC REHAB VISITS* 5,071 HOME HEALTH VISITS* 3,521 HOSPICE DAYS OF CARE* $623,757 IN FREE CARE* 96 VOLUNTEERS PROVIDED 6,521 HOURS OF VOLUNTEER SERVICE.THE CARE SERVICES WE PROVIDE THE FOLLOWING SPECIALTY SERVICES TO THE COMMUNITIES WE SERVE:* 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.* MAMMOGRAPHY: OUR MAMMOGRAPHY UNIT WAS DESIGNED FOR WOMEN AND IS STAFFED BY FEMALE PROFESSIONALS. * 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 ACCOMODATE 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.* SPEECH AND HEARING SERVICES: WE EMPLOY LICENSED AUDIOLOGIST AND SPEECH THERAPISTS THAT CAN HELP CORRECT HEARING LOSS AND SPEECH DIFFICULTIES.* 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.* WELLNESS PROGRAMS: OUR WELLNESS CENTER OFFERS THE COMMUNITY A FULL SCHEDULE OF CLASSES ON SUBJECTS RANGING FROM HEALTHY DIET, FITNESS AND PREVENTATIVE CARE ALONG WITH A FULLY EQUIPPED FITNESS CENTER TO HELP THE PEOPLE WE SERVE LEARN HOW TO MODIFY THEIR LIFESTYLES FOR A HEALTHIER LIFE.* 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 FRAIL ELDERLY TO REMAIN INDEPENDENT IN THEIR HOMES.* VOLUNTEERS AND VOLUNTEER SERVICES: WE HAVE, ON THE AVERAGE, 112 COMMUNITY VOLUNTEERS PROVIDING APPROXIMATELY 6,435 HOURS OF SERVICE TO THE HOSPITAL AND THE PATIENTS WE SERVE. SOME OF THE MANY AREAS THEY PROVIDE SERVICES ARE 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. * CARING TOUCH: A PARTNERSHIP WITH JAMESTOWN COLLEGE TO PROVIDE SUPPORT OF PATIENTS BOTH IN THE HOSPITAL AND AFTER THEY RETURN HOME.* OTHER SERVICES: COMMUNITY MEMBERS VOLUNTEER THEIR SERVICES TO HELP OUT IN TIMES OF NEED IN MOST SERVICE AREAS ASSISTING PATIENTS AND THEIR FAMILIES. SERVICES PROVIDED DURING FYE JUNE 30, 2013:*4,936 INPATIENT DAYS OF WHICH 430 WERE SWING BED AND 25 HOSPICE DAYS OF CARE* 45.1% MEDICARE IS THE PERCENTAGE OF INPATIENT DAYS* 13.9% MEDICAID IS THE PERCENTAGE OF INPATIENT DAYS* 8,486 EMERGENCY VISITS OF WHICH 802 RESULTED IN INPATIENT ADMISSIONS* 28,913 TOTAL OUTPATIENT VISITS* 2,521 OUTPATIENT SURGICAL PROCEDURE VISITS INCLUDING OUTPATIENT SURGERY AND SCOPES* 359 LIVE BIRTHS* 2,723 ORTHOPEDIC PATIENTS* 2,013 CARDIAC REHAB VISITS* 5,071 HOME HEALTH VISITS* 3,521 HOSPICE DAYS OF CARE* $623,757 IN FREE CARE* 96 VOLUNTEERS PROVIDED 6,521 HOURS OF VOLUNTEER SERVICE.IN SUMMARY, JAMESTOWN REGIONAL MEDICAL CENTER IS A 25 BED CRITICAL ACCESS HOSPITAL, GEOGRAPHICALLY LOCATED IN RURAL SOUTH-CENTRAL NORTH DAKOTA. THE CLOSEST MEDICAL FACILITY IS MORE THAN 35 MILES AWAY AND THE CLOSEST COMPARABLE MEDICAL SERVICES ARE 100 MILES FROM JAMESTOWN. | Description |
| Total Program Service Expense | 33478199 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 65 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 421 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRANDON VAUGHAN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7012521050 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2422 20TH ST SW | AddressLine1 |
| City | JAMESTOWN | City |
| State | ND | State |
| ZIP Code | 58401 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| DEREK BRICKNER MD | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| DEBRA A GEIER MD | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| ERIC MONSON | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| PAT NYGAARD | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| MONICA PELDO | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| DR JAMES R TORRANCE MD | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| CONNIE KRAPP | ||||||||
| CHAIRPERSON | 1.00 | X | 0 | 0 | 0 | X | ||
| DENNIS D POZARNSKY | ||||||||
| VICE CHAIRPERSON | 1.00 | X | 0 | 0 | 0 | X | ||
| REV TERRY ANDERSON | ||||||||
| SECRETARY | 1.00 | X | 0 | 0 | 0 | X | ||
| JOANNE H OTTMAR | ||||||||
| TREASURER | 1.00 | X | 0 | 0 | 0 | X | ||
| TODD HUDSPETH | ||||||||
| CEO | 40.00 | 226454 | 0 | 15102 | X | |||
| BRANDON VAUGHAN | ||||||||
| CFO | 40.00 | 9460 | 0 | 765 | X | |||
| DR MICHAEL DEAN | ||||||||
| ORTHOPEDIC SURGEON | 40.00 | 593857 | 0 | 18604 | X | |||
| DR PHILIP JYSTAD | ||||||||
| ER PHYSICIAN | 40.00 | 306382 | 0 | 47252 | X | |||
| DR SCOTT GOECKE | ||||||||
| PHYSICIAN | 40.00 | 273656 | 0 | 28498 | X | |||
| DR MANUEL HARRIS | ||||||||
| PODIATRIST | 40.00 | 224374 | 0 | 44716 | X | |||
| ALAN O'NEIL | ||||||||
| CFO (THRU MAY 2012) | 40.00 | 127782 | 0 | 4728 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1761965 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 159665 | TotalOtherCompensation |
| Number Individuals GT100 K | 19 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| AMERISOURCE BERGEN | |||||
| 27550 NETWORK PLACE | CHICAGO | IL | 60673 | PHARMACEUTICAL SERVICES | 1277615 |
| BIOMET INC | |||||
| 75 REMITTANCE DRIVE SUITE 3283 | CHICAGO | IL | 60675 | ORTHOPEDIC DEVICES & IMPLANTS | 813526 |
| NATIONAL MEDICAL RESOURCES INC | |||||
| 2900 E BROADWAY AVE STE 1 | BISMARCK | ND | 58501 | ER PHYSICIANS | 801066 |
| OWENS & MINOR | |||||
| 2151 COUNTY ROAD H2 WEST | MOUNDS VIEW | MN | 55112 | MEDICAL-SURGICAL SERVICES | 773935 |
| GE HEALTHCARE | |||||
| PO BOX 96483 | CHICAGO | IL | 60693 | RADIOLOGY EQUIPMENT | 614943 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 30 | NumberOfContractorsGT100K |
| Related Organizations | 76942 | RelatedOrganizations |
| All Other Contributions | 11000 | AllOtherContributions |
| Total Contributions | 87942 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621400 | 36170613 | 36170613 | |
| CAFETERIA | 900099 | 267891 | 267891 | |
| WELLNESS/LIFELINE/CARELINE | 900099 | 173501 | 173501 | |
| CONSULTATION SERVICES | 541900 | 85121 | 85121 | |
| TELEPHARMACIST | 541900 | 64692 | 64692 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 255373 | TotalRevenueColumn |
| Related Or Exempt Function Income | 255373 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 37017191 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 246386 | TotalRevenueColumn |
| Exclusion | $246,386 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 102953 | Securities |
| Other | 5350 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 1230 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 102953 | Securities |
| Other | 4120 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 107073 | TotalRevenueColumn |
| Exclusion | $107,073 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| BCBC INCENTIVE REVENE | 541900 | 250000 | 250000 | |
| LOSS ON IMPAIRMENT | 900099 | -401984 | -$401,984 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 18141 | TotalRevenueColumn |
| Related Or Exempt Function Income | 18141 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | -133843 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 37324749 | TotalRevenueColumn |
| Related Or Exempt Function Income | 37017441 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 267891 | UnrelatedBusinessRevenue |
| Exclusion | -$48,525 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 308295 | Total |
| Management And General | 308295 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14935565 | Total |
| Program Services | 12901766 | ProgramServices |
| Management And General | 2033799 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 791982 | Total |
| Program Services | 678597 | ProgramServices |
| Management And General | 113385 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1575502 | Total |
| Program Services | 1343819 | ProgramServices |
| Management And General | 231683 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1017823 | Total |
| Program Services | 862522 | ProgramServices |
| Management And General | 155301 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72295 | Total |
| Management And General | 72295 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 70433 | Total |
| Management And General | 70433 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3557820 | Total |
| Program Services | 3056807 | ProgramServices |
| Management And General | 501013 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 112983 | Total |
| Program Services | 6 | ProgramServices |
| Management And General | 112977 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4860402 | Total |
| Program Services | 4052105 | ProgramServices |
| Management And General | 808297 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 81913 | Total |
| Program Services | 52732 | ProgramServices |
| Management And General | 29181 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 783123 | Total |
| Program Services | 781121 | ProgramServices |
| Management And General | 2002 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 187433 | Total |
| Program Services | 116200 | ProgramServices |
| Management And General | 71233 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 112949 | Total |
| Program Services | 42713 | ProgramServices |
| Management And General | 70236 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2207935 | Total |
| Program Services | 2207935 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3931815 | Total |
| Program Services | 3931815 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 133764 | Total |
| Program Services | 59836 | ProgramServices |
| Management And General | 73928 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| DRUGS | 1550317 | 1550317 |
| BAD DEBT EXPENSE | 1303811 | 1303811 |
| FOOD | 235735 | 235735 |
| BLOOD | 121421 | 121421 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 230755 | Total |
| Program Services | 178941 | ProgramServices |
| Management And General | 51814 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38184071 | Total |
| Program Services | 33478199 | ProgramServices |
| Management And General | 4705872 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 249899 | BOY |
| EOY | 184793 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3024264 | BOY |
| EOY | 3326853 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6013077 | BOY |
| EOY | 4907812 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 552836 | BOY |
| EOY | 565772 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 103054 | BOY |
| EOY | 123579 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 59932242 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 10422260 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51905753 | BOY |
| EOY | 49509982 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7420386 | BOY |
| EOY | 7855695 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 624184 | BOY |
| EOY | 632681 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3034721 | BOY |
| EOY | 3845785 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 72928174 | BOY |
| EOY | 70952952 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3607478 | BOY |
| EOY | 3045667 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 637395 | BOY |
| EOY | 630941 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45632268 | BOY |
| EOY | 45255232 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 943616 | BOY |
| EOY | 636037 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50820757 | BOY |
| EOY | 49567877 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22107417 | BOY |
| EOY | 21385075 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22107417 | BOY |
| EOY | 21385075 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 72928174 | BOY |
| EOY | 70952952 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -859322 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 136980 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $5,198 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 5198 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | THE ORGANIZATION PAYS DUES TO VARIOUS PROFESSIONAL ORGANIZATIONS. A PORTION OF THOSE DUES ARE USED TOWARDS LOBBYING EXPENSES. THESE EXPENSES TOWARDS LOBBYING GO TOWARDS ADVOCATION FOR THE ORGANIZATIONS PURPOSE AND MISSION. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 613199 | OtherCostOrOtherBasis |
| Book Value | 613199 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 45650568 | OtherCostOrOtherBasis |
| Depreciation | 4382541 | Depreciation |
| Book Value | 41268027 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 407335 | OtherCostOrOtherBasis |
| Depreciation | 15502 | Depreciation |
| Book Value | 391833 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13103155 | OtherCostOrOtherBasis |
| Depreciation | 6024217 | Depreciation |
| Book Value | 7078938 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 157985 | OtherCostOrOtherBasis |
| Book Value | 157985 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 49509982 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (7 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| UNAMORTIZED DEBT ISSUE COSTS | 1291843 |
| HEALTH SAVINGS FUND | 481079 |
| BOND FUND | 291022 |
| BOND RESERVE | 559836 |
| DEBT SERVICE ESCROW | 308498 |
| EQUITY REPLACEMENT | 595092 |
| PENSION FUND | 318415 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 3845785 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CAPITAL LEASE OBLIGATION | Description |
| Amount | $636,037 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 636037 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 36157918 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 136980 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 136980 | RevenueNotRptdF990 |
| Revenue Subtotal | 36020938 | RevenueSubtotal |
| Other Revenues Not Included | 1303811 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 1303811 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 37324749 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 36880260 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 36880260 | ExpensesSubtotal |
| Other Expenses Not Included | 1303811 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 1303811 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 38184071 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE ORGANIZATION DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE ORGANIZATION HAS NOT RECORDED ANY ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS OF JUNE 30, 2013 OR 2012. THE ORGANIZATION'S FEDERAL RETURNS FOR TAX YEARS 2009 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSES 1,303,811. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSES 1,303,811. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 434662 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 434662 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01180 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2831655 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1942429 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 889226 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02410 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3266317 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1942429 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1323888 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03590 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7258 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8790 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -1532 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7258 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8790 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -1532 | NetCommunityBenefitExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3273575 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1951219 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1322356 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03590 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $908,738 | BadDebtExpenseAmount |
| Amount Attributable To | 850460 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 12961129 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 13275810 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -314681 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAMESTOWN REGIONAL MEDICAL CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2422 20TH ST SW | AddressLine1 |
| City | JAMESTOWN | City |
| State | ND | State |
| ZIP Code | 58401 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAMESTOWN REGIONAL MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 1 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Other Method | X | OtherMethod |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| All Needs Addressed | 0 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 7: THE COSTING METHODOLOGY IS THE COST TO CHARGES RATIO. | |
| PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1303811. | |
| PART II: JAMESTOWN REGIONAL MEDICAL CENTER PROVIDES SEVERAL LOW COST EDUCATIONAL TRAINING SESSIONS AT THE HOSPITAL AND AT DIFFERENT LOCATIONS IN THE COMMUNITY. FOR EXAMPLE, JAMESTOWN REGIONAL MEDICAL CENTER PROVIDES BREAST FEEDING, CAR SEAT TRAINING, PRENATAL TRAINING, AND HAPPIEST BABY ON THE BLOCK CLASSES. NEW YEAR NEW YOU FITNESS CHALLENGE WAS INTRODUCED IN 2008 TO ENCOURAGE AREA RESIDENTS TO MAKE POSITIVE LIFESTYLE CHANGES AND REDUCE THE RISK OF HEART DISEASE, DIABETES, OBESITY AND TOBACCO USE. | |
| PART III, LINE 4: 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.THERE WERE 368 GUARANTORS GIVEN CHARITY CARE IN FY 2013. THERE WAS A TOTAL OF $623,757 GIVEN AS CHARITY CARE IN FY 2013. THE AVERAGE CLAIM PER GUARANTOR WAS $1,694 AND THERE WERE AN ADDITIONAL 717 GUARANTORS WHO TOOK APPLICATIONS AND DID NOT RETURN THEM. | |
| PART III, LINE 8: THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO AS REQUIRED BY MEDICARE. SHORTFALL IS NOT INDICATIVE OF ANY CHANGE IN COMMUNITY BENEFIT AS THE COSTING METHODOLOGY AND DETERMINATION OF ALLOWABLE COSTS HAVE NOT CHANGED FROM PRIOR YEAR. | |
| 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. IF SUCH A PATIENT IS MISTAKENLY BILLED, HOSPITAL STAFF WILL APOLOGIZE FOR THE ERROR AND CORRECT THE MISTAKE. | |
| PART V, SECTION B, LINE 3: CONDUCTED A PAPER SURVEY IN LOGAN COUNTY. CONDUCTED AN IN-PERSON SURVEY, WEB SURVEY, TELEPHONE SURVEY, AND KEY INFORMANT SURVEYS IN STUTSMAN COUNTY. | JAMESTOWN REGIONAL MEDICAL CENTER |
| PART V, SECTION B, LINE 4: CENTRAL VALLEY HEALTH DISTRICTSANFORD HEALTH ESSENTIA HEALTHND STATE HOSPITAL | JAMESTOWN REGIONAL MEDICAL CENTER |
| PART V, SECTION B, LINE 5C: HOSPITAL'S WEBSITE LINK: WWW.JRMCND.COM/ABOUT/COMMUNITY-HEALTH/OTHER WEBSITE LINK: CENTRALVALLEYHEALTH.ORG/HIP.HTML | JAMESTOWN REGIONAL MEDICAL CENTER |
| PART V, SECTION B, LINE 7: THE TOP FOUR ISSUES WERE CHOSEN BASED ON WHICH WERE EASIEST TO IDENTIFY AND HAD THE MOST REALISTIC LEVEL OF ACHIEVING. | JAMESTOWN REGIONAL MEDICAL CENTER |
| PART V, SECTION B, LINE 20D: THE ORGANIZATION USES A SLIDING SCALE BASED ON RESPONSES TO THE FAP-ELIGIBLE APPLICATION. UPON KNOWING THE PATIENT IS ELIGIBLE THE SLIDING SCALE, BASED ON THE FEDERAL POVERTY GUIDELINES EXPLAINED IN PART I OF SCHEDULE H, IS UTILIZED TO PROVIDE THE MAXIMUM RATE BILLED. | JAMESTOWN REGIONAL MEDICAL CENTER |
| PART VI, LINE 2: JAMESTOWN REGIONAL MEDICAL CENTER HAS PARTNERED WITH CENTRAL VALLEY HEALTH AND OTHER LOCAL AGENCIES AND DEVELOPED A COMMUNITY HEALTH ASSESSMENT FOR THE 5 COUNTIES, STUTSMAN, BARNES, LOGAN, WELLS AND LAMOURE, SERVED BY CENTRAL VALLEY HEALTH AND JAMESTOWN REGIONAL MEDICAL CENTER. THIS ROLE WAS A PART OF THE HOSPITAL'S 5 YEAR STRATEGIC PLAN. | |
| 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 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 IN 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 FOR SOME OF ITS DEPARTMENTS. JAMESTOWN REGIONAL MEDICAL CENTER HAS COMPLETED CONSTRUCTION ON A REPLACEMENT HOSPITAL WHICH WILL HAVE MANY UPGRADES IN TECHNOLOGY, MOST OF WHICH ARE RELATED TO IMPROVING PATIENT CARE. | |
| PART VI, LINE 6: N/A |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | X | HousingAllowanceOrResidence |
| Written Policy Re T And E Expenses | 0 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TODD HUDSPETH | ||||||||||||||
| CEO | 226454 | 0 | 0 | 0 | 0 | 0 | 1297 | 0 | 13805 | 0 | 241556 | 0 | 0 | 0 |
| DR MICHAEL DEAN | ||||||||||||||
| ORTHOPEDIC SURGEON | 593857 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 18604 | 0 | 612461 | 0 | 0 | 0 |
| DR PHILIP JYSTAD | ||||||||||||||
| ER PHYSICIAN | 306382 | 0 | 0 | 0 | 0 | 0 | 27666 | 0 | 19586 | 0 | 353634 | 0 | 0 | 0 |
| DR SCOTT GOECKE | ||||||||||||||
| PHYSICIAN | 273656 | 0 | 0 | 0 | 0 | 0 | 26132 | 0 | 2366 | 0 | 302154 | 0 | 0 | 0 |
| DR MANUEL HARRIS | ||||||||||||||
| PODIATRIST | 224374 | 0 | 0 | 0 | 0 | 0 | 25790 | 0 | 18926 | 0 | 269090 | 0 | 0 | 0 |
| ALAN O'NEIL | ||||||||||||||
| CFO (THRU MAY 2012) | 127782 | 0 | 0 | 0 | 0 | 0 | 888 | 0 | 3840 | 0 | 132510 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | NEGOTIATED A HOUSING ALLOWANCE WITH AN EMPLOYEMENT AGREEMENT. |
| PART I, LINE 7 | 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 -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 2013, THE INCENTIVE PLAN FOR THE CEO WAS MAXED OUT AT 15% OF HIS BASE SALARY. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE PREPARER OF THE FORM 990 EMAILS A COPY OF THE FINAL 990 TO THE ORGANIZATION'S CHIEF FINANCIAL OFFICER. THE CHIEF FINANCIAL OFFICER PERFORMS A DETAIL REVIEW OF FORM 990. THE CHIEF FINANCIAL OFFICER PROVIDES EACH VOTING BOARD MEMBER WITH A COPY OF FORM 990 PRIOR TO SUBMITTING TO THE INTERNAL REVENUE SERVICE. | |
| FORM 990, PART VI, SECTION B, LINE 12C | 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. | |
| 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. PRIOR YEAR 990S CAN BE OBTAINED BY REQUEST OR THROUGH GUIDESTAR. | |
| FORM 990, PART IX, LINE 11G | OTHER PROFESSIONAL FEES : PROGRAM SERVICE EXPENSES 3,056,807. MANAGEMENT AND GENERAL EXPENSES 501,013. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,557,820. | OTHER FEES |
| FORM 990, PART XII, LINE 2C: | THE CHIEF FINANCIAL OFFICER ASSUMES OVERSIGHT OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS. THE BOARD OF DIRECTORS WITH THE CHIEF FINANCIAL OFFICER ASSUME RESPONSIBILITY FOR SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAMESTOWN REGIONAL MEDICAL CENTER FOUNDATION INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2422 20TH ST SW | AddressLine1 |
| City | JAMESTOWN | City |
| State | ND | State |
| ZIP Code | 58401 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363348763 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivities |
| Legal Domicile State | ND | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 11A, I | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LUTHERAN CHARITY ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 1 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| JAMESTOWN HOSPITAL FOUNDATION INC | ||
| C | 76942 | COST-AFFILIATED ORGANIZATION |
| JAMESTOWN HOSPITAL FOUNDATION INC | ||
| Q | 248133 | COST-AFFILIATED ORGANIZATION |
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