PRESENTATION MEDICAL CENTER: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- PRESENTATION MEDICAL CENTER (EIN 45-0227391)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-04-28
- IRS object ID
- 201431189349300448
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-04-28T14:29:48-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450250958 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3999 PENNSYLVANIA AVE SUITE 100 | AddressLine1 |
| City | DUBUQUE | City |
| State | IA | State |
| ZIP Code | 52002 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450227391 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Presentation Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PRES | NameControl |
| Phone | 7014773161 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 213 2nd Avenue NE | AddressLine1 |
| City | Rolla | City |
| State | ND | State |
| ZIP Code | 583670759 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Mark Kerr | Name |
| Title | President/CEO | Title |
| Phone | 7014773161 | Phone |
| Date Signed | 2014-04-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Carmen Krantz | Name |
| PTIN | P00031958 | PTIN |
| Phone | 5635561790 | Phone |
| Date Prepared | 2014-04-09 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Mark Kerr | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 213 2nd Avenue NE | AddressLine1 |
| City | Rolla | City |
| State | ND | State |
| ZIP Code | 583670759 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 9665136 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.pmc-rolla.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1939 | YearFormation |
| State Legal Domicile | ND | StateLegalDomicile |
| Activity Or Mission Description | Acute care hospital that is a major medical provider for Rolette County | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 134 | TotalNbrEmployees |
| Total Nbr Volunteers | 20 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 180809 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 421448 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 8945934 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 9213535 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 115701 | InvestmentIncomePriorYear |
| Investment Income Current Year | 11723 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -729 | OtherRevenuePriorYear |
| Other Revenue Current Year | -108 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 9241715 | TotalRevenuePriorYear |
| Total Revenue Current Year | 9646598 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 50 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 3982747 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 3938604 | 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 | 4789988 | OtherExpensePriorYear |
| Other Expenses Current Year | 4999855 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 8772735 | TotalExpensesPriorYear |
| Total Expenses Current Year | 8938509 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 468980 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 708089 | RevenuesLessExpensesCY |
| Total Assets BOY | 4086346 | TotalAssetsBOY |
| Total Assets EOY | 5005786 | TotalAssetsEOY |
| Total Liabilities BOY | 1562021 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1708366 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 2524325 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3297420 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | Presentation Medical Center in union with the Sisters of Mary of the Presentation, is a Catholic healthcare organization. Through the power and example of Jesus Christ and his gospel values, we are committed to joyfully provide wholistic care and healing with integrity, compassion and respect to all we serve. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 7643989 | Expense |
| Grants | 50 | Grants |
| Revenue | 9213535 | Revenue |
| Description | Presentation Medical Center (PMC) is a 25-bed not-for-profit, Critical Access Hospital (CAH) located in Rolla, Rolette County, ND. As a Critical Access Hospital, our organization is, by definition, a community benefit. PMC is a critical infrastructure to our community and is a major medical provider for Rolette County, providing inpatient, outpatient and surgical services. In addition, PMC is a key provider of emergency care with over 4,527 ER visits for fiscal year ending 2013. Services in the areas of Clinic, Lab, Radiology, Respiratory Therapy, Physical Therapy, Cardiac Rehab, and Outreach Specialty Physician services, are also provided.Presentation Medical Center had 215 acute patient days, 493 swing-bed days and 2,140 extended swing-bed days.The Medical Center provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the Medical Center does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The amounts of charges foregone were $134,298 for the year ended September 30, 2013. The estimated costs of the charges foregone, based upon an overall cost-to-charge ratio calculation, for the year ended September 30, 2013 were approximately $133,000.In addition, the Medical Center provides services to other medically indigent patients under certain government reimbursed public aid programs. Such programs pay providers amounts which are less than established charges for the services provided to the recipients, and for some services the payments are less than the cost of rendering the services provided. The Medical Center also commits significant time and resources to endeavors and critical services which meet otherwise unfulfilled community needs. Many of these activities are sponsored with the knowledge that they will not be self-supporting or financially viable. | Description |
| Total Program Service Expense | 7643989 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | 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 | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | 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 | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 4 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 134 | 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 | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 0 | 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 | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | 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 | Paula Wilkie | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7014773161 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 213 2nd Avenue NE | AddressLine1 |
| City | Rolla | City |
| State | ND | State |
| ZIP Code | 583670759 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (11 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| Nathan Neameyer | ||||||||
| Chairman | 0.50 | 0.00 | X | X | 0 | 0 | 0 | |
| Doug Kretschmar | ||||||||
| Vice Chairman | 0.50 | 0.00 | X | X | 0 | 0 | 0 | |
| Mark Kerr | ||||||||
| Secretary/President/CEO | 40.00 | 0.00 | X | X | 0 | 38013 | 2336 | |
| Sr Margaret Rose Pfeifer | ||||||||
| Director | 0.50 | 42.60 | X | 0 | 0 | 0 | ||
| Sr Marlyss Dionne | ||||||||
| Director | 0.50 | 41.30 | X | 0 | 0 | 0 | ||
| Sr Dorothy Bunce | ||||||||
| Director | 0.50 | 40.80 | X | 0 | 0 | 0 | ||
| Paul Grann | ||||||||
| Director | 0.50 | 0.00 | X | 0 | 0 | 0 | ||
| John Hardy | ||||||||
| Director | 0.50 | 0.00 | X | 0 | 0 | 0 | ||
| Jane Sivertson | ||||||||
| Director | 0.50 | 0.00 | X | 0 | 0 | 0 | ||
| Paula Wilkie | ||||||||
| CFO | 40.00 | 0.00 | X | 0 | 105886 | 24239 | ||
| Michael Pfeifer - until 93012 | ||||||||
| Former-Secretary/Pres/CEO | 0.00 | 0.00 | 0 | 249328 | 29739 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 393227 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 56314 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | 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 |
|---|---|---|---|---|---|
| Sisters of Mary of the Presentation Heal | |||||
| 1202 Page Dr SW | Fargo | ND | 58106 | Mgmt & Admin services | 456662 |
| Roy Cordy MD | |||||
| 914 3rd Avenue S Unit | Fargo | ND | 58103 | ER physician services | 362760 |
| AMN HealthCare | |||||
| PO Box 281939 | Atlanta | GA | 303841939 | Locum nursing services | 301670 |
| Dakota Travel Nurse | |||||
| 502 W Main Street | Mandan | ND | 58554 | Locum nursing services | 233694 |
| Homestead Recruiters | |||||
| 821 Senior Avenue | Dickinson | ND | 58601 | Locum provider services | 194540 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Government Grants | 168766 | GovernmentGrants |
| All Other Contributions | 252682 | AllOtherContributions |
| Total Contributions | 421448 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient service revenu | 622110 | 8505786 | 8505786 |
| EHR incentive | 900099 | 488472 | 488472 |
| Outside laundry revenu | 812300 | 130529 | 130529 |
| Supporting revenue | 900099 | 88748 | 88748 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 9213535 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 15895 | TotalRevenueColumn |
| Exclusion | $15,895 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 14258 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 14366 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -108 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -108 | TotalRevenueColumn |
| Exclusion | -$108 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 4172 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -4172 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -4172 | TotalRevenueColumn |
| Exclusion | -$4,172 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9646598 | TotalRevenueColumn |
| Related Or Exempt Function Income | 9213535 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $11,615 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50 | Total |
| Program Services | 50 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3348485 | Total |
| Program Services | 2944090 | ProgramServices |
| Management And General | 404395 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 98377 | Total |
| Program Services | 89052 | ProgramServices |
| Management And General | 9325 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 248483 | Total |
| Program Services | 218474 | ProgramServices |
| Management And General | 30009 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 243259 | Total |
| Program Services | 215578 | ProgramServices |
| Management And General | 27681 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 427860 | Total |
| Management And General | 427860 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7393 | Total |
| Management And General | 7393 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39430 | Total |
| Management And General | 39430 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2407875 | Total |
| Program Services | 2193829 | ProgramServices |
| Management And General | 214046 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13881 | Total |
| Management And General | 13881 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 417341 | Total |
| Program Services | 338856 | ProgramServices |
| Management And General | 78485 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 250959 | Total |
| Program Services | 248639 | ProgramServices |
| Management And General | 2320 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50219 | Total |
| Program Services | 37861 | ProgramServices |
| Management And General | 12358 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20099 | Total |
| Management And General | 20099 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17495 | Total |
| Program Services | 17495 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 395392 | Total |
| Program Services | 395392 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32400 | Total |
| Program Services | 32400 | ProgramServices |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| Medical supplies | 685372 | 685372 |
| Bad debt expense | 226901 | 226901 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7238 | Total |
| Management And General | 7238 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8938509 | Total |
| Program Services | 7643989 | ProgramServices |
| Management And General | 1294520 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 485660 | BOY |
| EOY | 177314 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1414889 | BOY |
| EOY | 1178897 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 161394 | BOY |
| EOY | 168180 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47073 | BOY |
| EOY | 49948 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 7636159 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 6361622 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1226244 | BOY |
| EOY | 1274537 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 372086 | BOY |
| EOY | 1229151 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30000 | BOY |
| EOY | 30000 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 349000 | BOY |
| EOY | 897759 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4086346 | BOY |
| EOY | 5005786 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 880050 | BOY |
| EOY | 968816 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 77764 | BOY |
| EOY | 51842 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 604207 | BOY |
| EOY | 687708 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1562021 | BOY |
| EOY | 1708366 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2524325 | BOY |
| EOY | 3060707 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 236713 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2524325 | BOY |
| EOY | 3297420 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4086346 | BOY |
| EOY | 5005786 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 708089 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 71105 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -6099 | 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 Both | X | FinancialStatementBoth |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | 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 D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 49958 | OtherCostOrOtherBasis |
| Book Value | 49958 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3824594 | OtherCostOrOtherBasis |
| Depreciation | 3714346 | Depreciation |
| Book Value | 110248 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3741786 | OtherCostOrOtherBasis |
| Depreciation | 2627455 | Depreciation |
| Book Value | 1114331 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 19821 | OtherCostOrOtherBasis |
| Depreciation | 19821 | Depreciation |
| Book Value | 0 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 1274537 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Estimated third-party payor settlements | 805000 |
| Other receivables | 92759 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 897759 | TotalBookValueOtherAssets |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 9238755 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 71105 | NetUnrealizedGainsInvestments |
| Other Revenues | -226901 | OtherRevenues |
| Revenue Not Rptd F990 | -155796 | RevenueNotRptdF990 |
| Revenue Subtotal | 9394551 | RevenueSubtotal |
| Other Revenues Not Included | 252047 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 252047 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 9646598 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 8711608 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 8711608 | ExpensesSubtotal |
| Other Expenses Not Included | 226901 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 226901 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 8938509 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Description of Uncertain Tax Positions Under FIN 48: | Part X, Line 2: | The Medical Center is organized as a North Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Medical Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Medical Center is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose, if applicable. The Medical 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 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 expenses for Form 990 -226,901. | |
| Part XI, Line 4b - Other Adjustments: | Temp restr contributions recorded in fund balance for financial statements 236,713. Unrestricted contributions recorded in fund balance for financial statements 15,334. | |
| Part XII, Line 4b - Other Adjustments: | Provisions for bad debts recorded in expenses for Form 990 226,901. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| 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 | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 139702 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 139702 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01600 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 139702 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 139702 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01600 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 5 | NumberOfActivitiesOrPrograms |
| Persons Served | 771 | PersonsServed |
| Total Community Benefit Expense | 24579 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9200 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 15379 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00180 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2490021 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2338485 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 151536 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01740 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 10097 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 10097 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00120 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 7 | NumberOfActivitiesOrPrograms |
| Persons Served | 771 | PersonsServed |
| Total Community Benefit Expense | 2524697 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2347685 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 177012 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02040 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 7 | NumberOfActivitiesOrPrograms |
| Persons Served | 771 | PersonsServed |
| Total Community Benefit Expense | 2664399 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2347685 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 316714 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03640 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 6 | NumberOfActivitiesOrPrograms |
| Persons Served | 6569 | PersonsServed |
| Total Community Building Expense | 8753 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 8753 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 6 | NumberOfActivitiesOrPrograms |
| Persons Served | 6569 | PersonsServed |
| Total Community Building Expense | 8753 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 8753 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $226,901 | BadDebtExpenseAmount |
| Amount Attributable To | 113450 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 3118917 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 3119312 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -395 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| 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 | Presentation Medical Center | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 213 2nd Avenue NE | AddressLine1 |
| City | Rolla | City |
| State | ND | State |
| ZIP Code | 583670759 | 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 |
| Other | 1 provider based clinic | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Presentation 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 |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| Other Needs Addressed | X | OtherNeedsAddressed |
| All Needs Addressed | 0 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Uninsured Discount | X | UninsuredDiscount |
| Other Factors | X | OtherFactors |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (19 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| Part I, Line 3c: Presentation Medical Center also evaluates a patient's family size and demographics to determine eligibility for additional free or discounted care to low income individuals. | |
| Part I, Line 6a: Presentation Medical Center's community benefit report can be found on its website at pmc-rolla.com. | |
| Part I, Line 7: Charity care expense was converted to cost on line 7a based on the cost-to-charge ratio derived from Worksheet 2. Inpatient and outpatient Hospital services provided to Medicaid program beneficiaries are primarily paid on a cost-related basis, therefore there is no community benefit related to Medicaid on line 7b. Community health improvement services and in-kind contributions to community groups, lines 7e and 7i, are reported based on actual expenses recorded in the organization's general ledger. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. | |
| Part I, L7 Col(f): The amount of bad debt expense removed from total expenses to determine the percentage was $226,901. | |
| Part II: The Social Service department provided information, assistance, and referrals to community members seeking such services, particularly during times of medical crisis.The area public schools participated in third grade tours. The schools are also offered the opportunity to participate in tours at the request of their teachers. Blood drives were conducted to help with the supply of blood in the area. Patients' health is at risk when the blood supply is low.The Presentations News Letter was provided to over 6,000 individuals providing the community with important health information.Caregiver meals were provided to 269 individuals. A caregiver gives so much of their time helping others they often don't have the time to get a meal. The meal is supplied so they can focus on caring for their loved one. | |
| Part III, Line 4: Bad debt expense is the write-off of a patient's account for services provided by the Hospital after all payments, discounts, and contractual allowances have been applied. Accounts that qualify or may qualify for financial assistance or charity care are not written off to bad debt. Payments received on accounts previously written off to bad debt reduces bad debt expense. Bad debt expense on line 2 is reported at charges as presented on the financial statements. The estimated amount of the Organization's bad debt expense attributable to patients eligible under the Organization's charity care policy is calculated based on an estimate of applications denied due to lack of information. Presentation Medical Center estimates the amount of bad debt expense attributable to patient's under the charity care policy because the Organization knows that some accounts are written off to bad debt that may have been charity care if the patient had completed the paper work.The footnote to the Organization's financial statements can be found on page 8 of the attached audited financial statements. | |
| Part III, Line 8: Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicaid and Medicare Services.Presentation Medical Center provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the Medicare shortfall is considered a community benefit. | |
| Part III, Line 9b: Presentation Medical Center believes it has an obligation to make every effort possible to collect for services rendered from all patients who have the ability to pay their account. There are no collection efforts for patients who qualify for charity care or financial assistance, indigent patients, or patients that have set up payment arrangements. If a portion of an account is written off to charity care, any personal portion due follows the same collection procedures as other accounts. For patients who are indigent, Presentation Medical Center has a Charity Care provision with the appropriate application process. For self pay patients, Presentation Medical Center offers a prompt payment discount of 25% for payment in full within 30 days from the date of their first statement. | |
| Part V, Section B, Line 3: A survey was distributed to gather feedback from the community. The survey was designed to collect information related to community-perceived health needs. Two versions of a survey tool were distributed to two different audiences: (1) community members and (2) health care professionals.One-on-one interviews with key informants were conducted in person in Rolla on June 18, 2012. Telephone interviews were held on June 21, 2012. A representative of the Center for Rural Health conducted the interviews. These interviewees represented the broad interests of the community served by PMC. They included representatives of the medical community, business community, nonprofit agencies, and public health. Included among the informants was a public health nurse with special knowledge in public health acquired through several years of direct care experience in the community, including working with medically underserved, low income and Native populations, as well as with populations with chronic diseases. Also included was an employee from Job Service North Dakota who interacts with low income and minority populations.A focus group met and included the Mayor, medical service providers, business leaders and city personnel from various communities in Presentation Medical Center's service area. | Presentation Medical Center |
| Part V, Section B, Line 5c: Presentation Medical Center's community health needs assessment is available on their website at www.pmc-rolla.com. | Presentation Medical Center |
| Part V, Section B, Line 6i: Presentation Medical Center has adopted an implementation strategy to address the community health needs identified in its Community Health Needs Assessment. The implementation strategy is posted to the Hospital's website at www.pmc-rolla.com. | Presentation Medical Center |
| Part V, Section B, Line 7: The assessment identified and requested the addition of services that Presentation Medical Center is unable to provide at this time. Those services include:1. A surgeon who lives in Rolla, ND. This service requires not only a surgeon, but also extensive support staff, including specialty nurses and either an anesthesiologist or nurse anesthetist.2. An obstetrician for maternity care and deliveries, since there is a high birth rate in the area. As stated above, this service would also require anesthesiology, specialty nurses and support staff. Additionally, the malpractice insurance premiums are high, and logistical support would result in unjustifiable costs.3. Occupational therapy service requires specialty personnel and equipment, as well as designated space for a treatment room and office.While all these programs would be beneficial to the community, the logistics, personnel and resources to provide these services are not readily available or financially feasible. | Presentation Medical Center |
| Part V, Section B, Line 12h: Presentation Medical Center also evaluates a patient's family size, income and demographics to determine eligibility for additional free or discounted care to low income individuals. | Presentation Medical Center |
| Part V, Section B, Line 14g: A brochure is provided to every patient when they register outlining our payment expectations and explaining our Community Caring Program. An application for the Community Caring Program is included with the first statement of every private pay patient. Our Charity Care application can be obtained on our website. Notification about charity care is available in emergency rooms, admitting and registration departments, the Business office, and other public areas within the Hospital. Information is also included in patient bills and patient information packets. At registration, patients are given the Payment Policy and Community Caring Program handout. This handout explains patient responsibilities, insurance billing guidelines, financing and payment options, and the Community Caring guidelines. | Presentation Medical Center |
| Part VI, Line 2: Presentation Medical Center strives to provide basic healthcare services to its communities. We have worked with the Public Health for Rolette County, Rolette County Police Department, Rolla Community Ambulance, Rolette County Social Services and other community departments to provide basic care to the members of our community. Working with these individuals allows us to provide different services to our community and to make sure that one of these entities is able to provide care and or cover for one another.Our community health needs assessment was completed by the due date September 30, 2013 and posted to our website to meet the requirements of 501(r). | |
| Part VI, Line 3: Presentation Medical Center is committed to providing care to persons who are uninsured, underinsured, ineligible for government programs, or otherwise unable to pay for medically necessary care. Our Community Caring Program was established in 2005. We have seen a continual increase every year in charity care as we try to get patients involved in the program before their accounts are sent to collections. A brochure is provided to every patient when they register outlining our payment expectations and explaining our Community Caring Program. An application for the Community Caring Program is included with the first statement of every private pay patient. This year, we added the application to our website. Notification about charity care is available in emergency rooms, admitting and registration departments, the Business office, and other public areas within the Hospital. Information is also included in patient bills and patient information packets. At registration, patients are given the Payment Policy and Community Caring Program handout. This handout explains patient responsibilities, insurance billing guidelines, financing and payment options, and the Community Caring guidelines. | |
| Part VI, Line 4: Presentation Medical Center (PMC) is a 25-bed not-for-profit, Critical Access Hospital (CAH) located in Rolla, Rolette County, ND. Rolla, ND is located in north central North Dakota, next to the Canadian border. Presentation Medical Center is located approximately 40 miles from Bottineau, 120 miles northeast of Minot, 170 miles northwest of Grand Forks, 205 miles northeast of Bismarck, and 240 miles northwest of Fargo. The nearest city with a population > 50,000 is Bismarck, ND.PMC is highly dependent upon government payors and is a Medicaid Disproportionate Share Hospital. In the Fiscal Year ending 09/30/2013, revenue from the Medicare, Medicaid, and Blue Cross programs accounted for approximately 34%, 28%, and 17% of the Medical Center's gross patient service revenue. By virtue of where we are located and the services that we provide, we are a benefit to our community.The service area of PMC includes Rolette and part of Towner Counties. Rolette County has a total population of 14,206 with 75% of the population being Native American. With this census, 2.08% of North Dakota's population lives in Rolette County. The per capita income for Rolette County is $13,632 compared with North Dakota's per capita income of $25,803 with 31.8% of the county living below the poverty guidelines. (Source: U.S. Census Bureau).The closest healthcare facility is 7 miles away located in Belcourt, ND, which is an Indian Healthcare Facility. All other hospitals are located 40 plus miles from Presentation Medical Center. Presentation Medical Center's tertiary facility is located over 120 miles away in Minot, ND. It is in the best interest of the community to be able to offer basic healthcare needs due to the distance that the patient must travel. | |
| Part VI, Line 5: Presentation Medical Center works to address the basic healthcare needs in Rolette County and the surrounding communities. The Hospital is a major medical provider for the county providing inpatient, outpatient, and surgical services. In addition, Presentation Medical Center is a key provider of emergency care. The emergency room is open 24 hours and is available regardless of a persons ability to pay.Presentation Medical Center extends medical staff privileges to all qualified physicians who meet PMC's Medical Staff Bylaws. Surplus funds are used for equipment upgrades and facility improvements. A majority of the organization's governing body resides in Rolla, ND and none are employees nor contractors of the organization. The governing body does not have any family relationships with each other.In addition to our very existence, PMC believes that there are additional areas that highlight our benefit to the community. By being what and who we are, we strive to be a good community citizen and an asset to the communities that we serve. PMC routinely provides a variety of services that address needs within the community.PMC provided an annual Healthy Community Day that offers educational material and health screenings, including laboratory screenings that provide information about an individuals' general health condition. These services are offered to all community residents.PMC provides information about health issues and topics of interest to the community in our Presentations News Letter. Physical Therapy students also had the opportunity to obtain clinical experience at PMC.Blood drives are sponsored four times per year. United Blood Services uses the Inservice Room as a collection site and the Lab and Admission staff members are responsible for recruiting and coordinating donors.Staff support and office space is provided to the Rural Mental Health Consortium. This allows mental health services to be available in the community on a weekly basis.Meals are also provided for caregivers and lodging is offered for family members who choose to remain in the hospital with their loved one.Sport Injury evaluation and screenings are provided to area High School students and staff members from Physical Therapy provide support at local athletic events.Meeting Room space is provided for Weight Watchers, Support Groups, Paramedic Education, Ministerial Association, Hearing Aid Testing, 4-H meetings and any other groups needing meeting space. | |
| Part VI, Line 6: We are an affiliate of the Sisters of Mary of the Presentation Health Corporation. Presentation Medical Center operates in accordance with the mission, vision, and values of the Sisters of Mary of the Presentation Health Corporation. Our annual budgeting process includes an assessment of how our budget demonstrates a commitment to the values of the system and the system works to ensure we are always mindful of our duty to care for the poor and those in need. Presentation Medical Center has a Strategic Plan developed from themes set forth by the health system for all affiliates. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | 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 | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Michael Pfeifer - until 93012 | NamePerson |
| Title | Former-Secretary/Pres/CEO | Title |
| Base Compensation Filing Org | 0 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 208042 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 0 | BonusFilingOrg |
| Bonus Related Orgs | 31051 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 10235 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 0 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 22046 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 0 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 9868 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 0 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 281242 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Supplemental Information | Identifier |
| Return Reference | Part III | ReturnReference |
| Explanation | Part I, Question 3: Presentation Medical Center does not pay compensation to the President/CEO. This individual is compensated by Sisters of Mary of the Presentation Health Corporation, a related organization, for services to the Medical Center. Sisters of Mary of the Presentation Health Corporation uses one or more of the methods in Part I, question 3 to determine compensation. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 2 | Mark Kerr, Paula Wilkie and Sr. Margaret Rose Pfeifer have business relationships with each other. | |
| Form 990, Part VI, Section A, line 6 | The sole member of the organization is the Sisters of Mary of the Presentation Health Corporation. | |
| Form 990, Part VI, Section A, line 7a | The member is entitled to vote in the election of Directors and to cast one vote for each Director to be elected. The member is also entitled to one vote on every other matter to be voted on by the member. Votes cast on behalf of the member are cast by the Chief Executive Officer of Sisters of Mary of the Presentation Health Corporation. | |
| Form 990, Part VI, Section A, line 7b | The authority to act on the following matters are exclusively vested in the member of the organization: 1. any change in the philosophy, objectives and purposes of the organization; 2. amendment of the articles of incorporation and bylaws; 3. the election or removal of the Directors; 4. merger or consolidation with any other organization; 5. dissolution of the organization or the sale, lease or exchange of all or substantially all of its property or assets; 6. the sale, lease, transfer or encumbrance of any land, buildings or other assets owned by the organization or in which the organization has or will have equitable or legal title; 7. approval of the annual operating and capital budgets; 8. appointment of the Chief Executive Officer. | |
| Form 990, Part VI, Section A, line 8b | The organization does not have committees with authority to act on behalf of the governing body. | |
| Form 990, Part VI, Section B, line 11 | The Form 990 is distributed to the governing body before it is filed. The CEO and CFO review the Form 990. | |
| Form 990, Part VI, Section B, line 12c | Each Director must submit in writing to the Chairperson of the Board and the CEO a list of all business or other organizations of which the individual is an officer, director, trustee, member, owner (either as a sole proprietor or partner), shareholder with a 5% or greater interest in all outstanding voting shares, employee or agent, with which the organization has, or might reasonably in the future enter into, a relationship or a transaction in which the Director would have conflicting interests. Each written statement is resubmitted with any necessary changes each year. The Chairperson of the Board reviews the statements of the Directors and the Vice Chairperson of the Board reviews the statement filed by the Chairperson. When a conflict arises the affected Director makes known the potential conflict, whether disclosed by written statement or not, and after answering any questions, will withdraw from the meeting for as long as the matter continues under discussion. Should the matter be brought to a vote, the affected Director will not vote on it. In the event the Director does not withdraw voluntarily, the Chairperson of the Board has authority to require the Director to remove himself from the room during both the discussion and vote on the matter. In the event the conflict of interest affects the Chairperson, the Vice Chairperson has authority to require the Chairperson remove himself in the same matter. If the matter is the item of business for which a special meeting of the Board was called, the affected Director will not be counted to establish a quorum, and he will not participate in the deliberations or vote on it. | |
| The organization's CEO and CFO are both compensated by Sisters of Mary of the Presentation Health Corporation, a related organization. The compensation process is determined by the related organization. The Sisters of Mary of the Presentation Health Corporation Board of Trustees directly engages a nationally recognized independent compensation consulting firm to review the total compensation arrangements of the officers and key employees. The Sisters of Mary of the Presentation Health Corporation Board of Trustees approves all compensation based on comparable data and documents their decision in the meeting minutes. | ||
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents, conflict of interest policy, and financial statements are available to the public upon written request. | |
| Form 990, Part IX, line 11g | Purchased services: Program service expenses 1,977,603. Management and general expenses 45,445. Fundraising expenses 0. Total expenses 2,023,048. Repairs and maintenance: Program service expenses 216,226. Management and general expenses 162,653. Fundraising expenses 0. Total expenses 378,879. Professional fees: Program service expenses 0. Management and general expenses 5,948. Fundraising expenses 0. Total expenses 5,948. | Other Fees |
| Form 990, Part XI, line 9: | Equity transfer to Sisters of Mary of the Presentation Health Corporation -6,099. | Changes in Net Assets or Fund Balances: |
| Form 990, Part XII, Line 2c: | The governing board of Sisters of Mary of the Presentation assumes responsibility for oversight of the audit for Presentation Medical Center. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (9 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Sisters of Mary of the Presentation Health Corporation | |||||||||||
| 1202 Page Drive SW | Fargo | ND | 58103 | 450359620 | Facilitates management and operations of ten related facilities | ND | 501(c)(3) | Line 11a, I | SMP Maryvale Provincial Center | 0 | |
| St Andrew's Hospital Foundation | |||||||||||
| 316 Ohmer Street | Bottineau | ND | 58318 | 450413201 | Provide support to St. Andrew's Hospital | ND | 501(c)(3) | Line 11a, I | SMP Health Corporation | 0 | |
| SMP Prairieland Home Health Agency | |||||||||||
| 1102 Page Drive SW | Fargo | ND | 581060007 | 450391192 | Home health and supportive services | ND | 501(c)(3) | Line 9 | SMP Health Corporation | 0 | |
| St Andrew's Hospital | |||||||||||
| 316 Ohmer Street | Bottineau | ND | 58318 | 450226426 | Provision of health care services | ND | 501(c)(3) | Line 3 | SMP Health Corporation | 0 | |
| St Aloisius Hospital | |||||||||||
| 325 East Brewster Street | Harvey | ND | 58341 | 450226729 | Provision of health care services | ND | 501(c)(3) | Line 3 | SMP Health Corporation | 0 | |
| St Margaret's Hospital | |||||||||||
| 600 East First Street | Spring Valley | IL | 61362 | 362167884 | Provision of health care services | IL | 501(c)(3) | Line 3 | SMP Health Corporation | 0 | |
| Sisters of Mary of the Presentation Long Term Care | |||||||||||
| 1202 Page Drive SW | Fargo | ND | 581060007 | 752999939 | Provide extended care and medically related services | ND | 501(c)(3) | Line 9 | SMP Health Corporation | 0 | |
| St Margaret's Hospital Foundation | |||||||||||
| 600 East First Street | Spring Valley | IL | 61362 | 364042262 | Provide support to St. Margaret's Hospital | IL | 501(c)(3) | Line 11a, I | SMP Health Corporation | 0 | |
| Sisters of Mary of the Presentation Maryvale Provincial Center | |||||||||||
| 11550 River Road | Valley City | ND | 58072 | 450281923 | Work for the glory of God | ND | 501(c)(3) | Line 1 | 0 | N/A | |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Andrew's Bottineau Clinic LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 316 Ohmer Street | AddressLine1 |
| City | Bottineau | City |
| State | ND | State |
| ZIP Code | 58318 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450451306 | EIN |
| Primary Activity | Provision of health care services | PrimaryActivity |
| Legal Domicile State | ND | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Rolette Clinic Inc | |||||||||||||
| PO Box 759 | Rolla | ND | 58367 | 450308335 | Leasing | ND | Presentation Medical Center | C | 9585 | 1797 | 0.66670 | 1 | |
| SMP Enterprises | |||||||||||||
| PO Box 10007 | Fargo | ND | 581060007 | 363486506 | Home health care services | ND | C | 0 | N/A | ||||
| 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 | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | 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 | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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