HILLSBORO MEDICAL CENTER: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- HILLSBORO MEDICAL CENTER (EIN 45-0230400)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-07
- IRS object ID
- 201311279349300966
- Schema version
- 2011v1.5
- 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 | 2013-05-07T11:12:12-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | 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 | 4310 17TH AVE S PO BOX 2545 | AddressLine1 |
| City | FARGO | City |
| State | ND | State |
| ZIP Code | 581082545 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450230400 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HILLSBORO MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | HILL | NameControl |
| Phone | 7016363201 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 609 | AddressLine1 |
| City | HILLSBORO | City |
| State | ND | State |
| ZIP Code | 58045 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Jac McTaggart | Name |
| Title | CEO | Title |
| Phone | 7016363201 | Phone |
| Date Signed | 2013-05-06 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | LISA CHAFFEE CPA | Name |
| PTIN | P00193453 | PTIN |
| Phone | 7012398500 | Phone |
| Date Prepared | 2013-05-06 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Jac McTaggart | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 609 | AddressLine1 |
| City | HILLSBORO | City |
| State | ND | State |
| ZIP Code | 58045 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 8138945 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.hillsboromedicalcenter.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1946 | YearFormation |
| State Legal Domicile | ND | StateLegalDomicile |
| Activity Or Mission Description | To provide quality health care and living services with dignity and individualized care. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 192 | TotalNbrEmployees |
| Total Nbr Volunteers | 30 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 396438 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 632997 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 7095839 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 7404562 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 57162 | InvestmentIncomePriorYear |
| Investment Income Current Year | 24138 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 76019 | OtherRevenuePriorYear |
| Other Revenue Current Year | 77248 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 7625458 | TotalRevenuePriorYear |
| Total Revenue Current Year | 8138945 | 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 | 4008975 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 4163425 | 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 | 3859550 | OtherExpensePriorYear |
| Other Expenses Current Year | 3991832 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 7868525 | TotalExpensesPriorYear |
| Total Expenses Current Year | 8155257 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -243067 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -16312 | RevenuesLessExpensesCY |
| Total Assets BOY | 15718023 | TotalAssetsBOY |
| Total Assets EOY | 16039565 | TotalAssetsEOY |
| Total Liabilities BOY | 13412557 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 13792723 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 2305466 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 2246842 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | The mission of the Hillsboro Medical Center is to provide quality health care and living services with dignity and individualized care. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 7914002 | Expense |
| Revenue | 7404562 | Revenue |
| Description | The Hospital/Home provides medical care to the community and long-term care to the elderly regardless of the individual's ability to pay for the services received.Medical services offered include critical access hospital services, skilled nursing services, emergency services and ambulance services. To fulfill its mission of community service, the Medical Center provides care to patients and residents who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the Medical Center does not pursue collection of amounts determined to qualify for charity care, they are not reported as patient and resident service revenue.The Medical Center maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy and equivalent service statistics. The amounts of charges foregone, based on established rates, were $9,563 and $14,804 for the years ended June 30, 2012 and 2011.Hillsboro Medical Services also operates a skilled nursing facility. The Home provides nursing services, meals, housekeeping, laundry and activities for residents. | Description |
| Total Program Service Expense | 7914002 | 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 | 1 | 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 | 0 | 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 | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| 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 | 12 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 192 | 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 | 1 | 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 | Darlene Swanson | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7016363211 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 609 | AddressLine1 |
| City | Hillsboro | City |
| State | ND | State |
| ZIP Code | 58045 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| Kathy Evenson | ||||||
| Chair | 3.00 | X | X | 0 | 0 | 0 |
| Jeff McInnes | ||||||
| Vice Chair | 1.00 | X | X | 0 | 0 | 0 |
| Brenda Muller | ||||||
| Secretary | 1.00 | X | X | 0 | 0 | 0 |
| Ed Laxdal | ||||||
| Treasurer | 1.00 | X | X | 0 | 0 | 0 |
| Wes Ecker | ||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |
| Wayne Koering | ||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |
| Cel Baumgartner | ||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |
| Doug Melby | ||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |
| Lisa Rotvold | ||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |
| Joy Hollinshead | ||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | |
| Scott Awalt | ||||||
| CFO | 12.00 | X | 0 | 0 | 0 | |
| Jac McTaggart Starting 12012 | ||||||
| CEO/Administrator | 40.00 | X | 0 | 0 | 0 | |
| John Rieke Thru 92011 | ||||||
| CEO/Administrator | 40.00 | X | 87218 | 0 | 5776 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 87218 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 5776 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Sanford Health | |||||
| PO Box 2010 | Fargo | ND | 58122 | Various Medical Service Contracts and Ma | 517829 |
| DMS Health | |||||
| SDS 12-2208 PO Box 86 | Minneapolis | MN | 55486 | X-Ray Fees | 106836 |
| Dakota Travel Nurse Inc | |||||
| 502 W Main St | Mandan | ND | 58554 | Contracted Nursing Services | 105736 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| Related Organizations | 443386 | RelatedOrganizations |
| Government Grants | 169266 | GovernmentGrants |
| All Other Contributions | 20345 | AllOtherContributions |
| Total Contributions | 632997 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Net Patient & Resident | 621300 | 7368839 | 7368839 |
| Supporting Revenue | 900099 | 35723 | 35723 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 7404562 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 24138 | TotalRevenueColumn |
| Exclusion | $24,138 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 77248 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 77248 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 77248 | TotalRevenueColumn |
| Exclusion | $77,248 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8138945 | TotalRevenueColumn |
| Related Or Exempt Function Income | 7404562 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $101,386 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 126373 | Total |
| Management And General | 126373 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3453000 | Total |
| Program Services | 3453000 | ProgramServices |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65805 | Total |
| Program Services | 65805 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 214104 | Total |
| Program Services | 214104 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 304143 | Total |
| Program Services | 304143 | ProgramServices |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22460 | Total |
| Management And General | 22460 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32359 | Total |
| Management And General | 32359 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 861338 | Total |
| Program Services | 861338 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24260 | Total |
| Management And General | 24260 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 108467 | Total |
| Program Services | 72664 | ProgramServices |
| Management And General | 35803 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 194909 | Total |
| Program Services | 194909 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32635 | Total |
| Program Services | 32635 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19410 | Total |
| Program Services | 19410 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 691173 | Total |
| Program Services | 691173 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1196047 | Total |
| Program Services | 1196047 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72576 | Total |
| Program Services | 72576 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| Medical Supplies | 459808 | 459808 |
| Food | 133990 | 133990 |
| Bad debts | 121077 | 121077 |
| Recognition | 2198 | 2198 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19125 | Total |
| Program Services | 19125 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8155257 | Total |
| Program Services | 7914002 | ProgramServices |
| Management And General | 241255 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1204470 | BOY |
| EOY | 1088915 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1315958 | BOY |
| EOY | 2374912 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29715 | BOY |
| EOY | 35466 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45787 | BOY |
| EOY | 47452 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 17631455 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 6559484 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11562769 | BOY |
| EOY | 11071971 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1145364 | BOY |
| EOY | 1106796 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 413960 | BOY |
| EOY | 314053 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15718023 | BOY |
| EOY | 16039565 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 514992 | BOY |
| EOY | 717282 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 79914 | BOY |
| EOY | 94558 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12790000 | BOY |
| EOY | 12595000 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14288 | BOY |
| EOY | 15672 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 357492 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13363 | BOY |
| EOY | 12719 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13412557 | BOY |
| EOY | 13792723 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2305466 | BOY |
| EOY | 2246842 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2305466 | BOY |
| EOY | 2246842 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15718023 | BOY |
| EOY | 16039565 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -16312 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -42312 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtc |
| Included On FS | 1 | IncludedOnFS |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13783374 | OtherCostOrOtherBasis |
| Depreciation | 4329776 | Depreciation |
| Book Value | 9453598 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3539464 | OtherCostOrOtherBasis |
| Depreciation | 2199155 | Depreciation |
| Book Value | 1340309 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 308617 | OtherCostOrOtherBasis |
| Depreciation | 30553 | Depreciation |
| Book Value | 278064 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 11071971 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Unamortized Bond Premium | Description |
| Amount | $12,719 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 12719 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part IV, Line 2b: | The Medical Center holds tenant security deposits from assisted living residents. These funds are included in cash and accounts payable in the consolidated financial statements. Tenant security deposits totaled $15,672 and $14,288 at June 30, 2012 and 2011. | |
| Part X: | The Medical Center and the Foundation are organized as North Dakota nonprofit corporations and have 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 and the Foundation are required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS annually. In addition, the Medical Center and the Foundation are subject to income tax on any net income that is derived from business activities that are unrelated to its exempt purpose. The Medical Center and the Foundation believe they have appropriate support for any tax positions taken affecting the annual filing requirements for the Medical Center and the Foundation, and as such, do not have any uncertain tax positions that are material to the consolidated financial statements. The Medical Center and the Foundation would recognize future accrued interest and penalties related to unrecognized tax liabilities in income tax expense if such interest and penalties are incurred. | Description of Uncertain Tax Positions Under FIN 48: |
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 | 0 | FPGReferenceFreeCare |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | 0 | 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 | 11000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 11000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2052708 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2044119 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8589 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2063708 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2044119 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 19589 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00250 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 500 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 500 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 420869 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 274537 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 146332 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01820 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 421369 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 274537 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 146832 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01830 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2485077 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2318656 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 166421 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02080 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $121,077 | BadDebtExpenseAmount |
| Amount Attributable To | 90808 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 1628321 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 1612199 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 16122 | 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 | 0 | 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 | Hillsboro Medical Center | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12 3rd St SE | AddressLine1 |
| City | Hillsboro | City |
| State | ND | State |
| ZIP Code | 58045 | 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 | Ambulance | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hillsboro Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 0 | UsesFPGFree |
| Uses FPG Discounted | 0 | UsesFPGDiscounted |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| Hillsboro Medical Center Nursing Home | ||||
| 12 3rd St SE | Hillsboro | ND | 58045 | Skilled Nursing |
| Comstock Corner | ||||
| 12 3rd St SE | Hillsboro | ND | 58045 | Assisted Living |
Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)
| ExplanationExplanation | Return ReferenceReturnReference | IdentifierIdentifier |
|---|---|---|
| Part I, Line 3c: Throughout the payment and collection process, the business office staff attempt to identify to the extent possible, patients who may be eligible for charity care considerations. Individuals with accounts to be considered for charity reductions are asked to complete a financial statement form, which provides pertinent financial information necessary to determine financial need. The charity care application asks for items such as employment information, current income, current expenses, assets owned as well as other miscellaneous items. Credit reports are also used to verify and assist in the decision process. This information is also compared against the federal poverty guidelines. Review of potential charity requests are performed monthly by the Business Manager and certain recommendations are forwarded to the Administrator. The Administrator reviews all information in the charity care application and bases a decision for charity care on all factors included in the application. | ||
| Part I, Line 7: An average ratio of cost to gross charges, which addresses all patient segments, was used to determine the amount of Financial Assistance at cost on Part I, line 7a. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. Subsidized health services on line 7g was calculated using the cost report. Community health improvement services, line 7e, were calculated based on estimated costs. | ||
| Part I, L7 Col(f): The amount of bad debt expense removed from total expenses to determine the percentage was $121,077. | ||
| Part II: n/a | ||
| Part III, Line 4: Financial Statement Bad Debt Expense Footnote:The carrying amount of patient and resident receivables is reduced by a valuation allowance that reflects management's estimate of amounts that will not be collected from patients, residents, and third-party payors. Management reviews patient and resident receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients and residents due to bad debts. Management considers historical write-off and recovery information in determining the estimated bad debt provision.All discounts and payments on a patient's account are accounted for prior to determining bad debt expense. Hillsboro Medical Center reports amounts as bad debt once they are 120 days overdue and have been turned over to a collection agency. Historically, almost all of these amounts remain unpaid as the patient does not have sufficient resources and likely would qualify for the Charity Care Program. Based on this assumption, 75% of the bad debt amount is considered charity care. | ||
| Part III, Line 8: Medicare allowable costs of care are based on the Medicare Cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. | ||
| Part III, Line 9b: As of 6/30/12, the collection policy did not contain specific written provisions on collection practices to be followed for patients who are known to qualify for financial assistance. However in practice, when it is appropriate, a review is done to determine if a patient qualifies for charity care (all patients are evaluated on an individual basis). This can be discussed with the patient during the phone call prior to sending to collections. All collection efforts are reversed if a patient is determined to be eligible for financial assistance. | ||
| The Organization began re-writing some of their policies during the year in order to be in compliance with IRC 501(r). This process was halted because the Organization was in the process of becoming affiliated with Sanford Health and knew that when the affiliation was official they would adopt the policies and procedures of Sanford Health. The Organization will become part of Sanford Health as of January 1st, 2013. | Schedule H, Part V, Section B | |
| Part V, Section B, Line 9: We have a charity care application available requesting financial and employment information. Items requested include but are not limited to, household income, household expense, insurance benefits, and assets. Administration reviews the application and bases a decision for charity care on all factors and compares data to federal poverty guidelines. Notes are made on the statements informing patients that charity care applications are available if they are unable to pay. | Hillsboro Medical Center | |
| Part V, Section B, Line 10: No discounted care was provided during the fiscal year. | Hillsboro Medical Center | |
| Part V, Section B, Line 13g: The Organization informs patients about the Charity Care Policy during the collection process and indicates which pertinent information is needed in order to determine financial need. As of the fiscal year end, the Organization is working on making the Charity Care Policy more widely available to the public in order to be in compliance with IRC 501(r). | Hillsboro Medical Center | |
| Part V, Section B, Line 19d: During the fiscal year, individuals who were eligible for charity care received a 100% write off applied to the gross charges on their bill. There were no other lesser discounts offered.Effective January 2013, the Organization will be affiliated with Sanford Health. They will adopt the amounts generally billed calculations currently in use by Sanford Health. The minimum discount for those that qualify will be calculated by using the weighted average of the contractual adjustments provided to the three largest commercial insurance companies during the prior calendar year. | Hillsboro Medical Center | |
| Part VI, Line 2: The Assistant Director of Nursing and the Medical Providers at Hillsboro Medical Center assess the needs of outpatient services utilized by the community. We re-evaluate the services we provide and have added multiple needed outpatient treatments. These services enhanced patient care and provided services within our community instead of needing to travel outside the Hillsboro area for these services. The Organization began planning a Community Health Needs Assessment during the year as well to help assess the needs of the community. We will continue to review the needs of the community and the services that we offer. | ||
| Part VI, Line 3: During the collection process for outstanding bills, Hillsboro Medical Center (HMC) informs the patients that they do have a Charity Care Policy and they will send out a financial statement form, which will provide pertinent patient financial information necessary to determine financial need. Also, HMC discusses with the patients that they could apply with the county for Medicaid assistance. The final determination for Charity Care is approved by the Administrator after reviewing all pertinent factors. | ||
| Part VI, Line 4: Hillsboro Medical Center is a 16-bed acute care hospital, a 36-bed nursing facility, and a 16-unit assisted living facility located in Hillsboro, North Dakota. Hillsboro has a population of approximately 1,603 per the 2010 Census data. Per the 2007-2011 American Community Survey's 5 year estimates, the median income for a household in the city was $43,629 and the median income for a family was $56,719. Males (working year-round and full-time) had a median income of $43,182 versus $30,655 for females. The per capita income for the city was $20,791. About 4.2% of families and 8.4% of the population were below the poverty line, including 7.6% of those under age 18 and 11.2% of those age 65 or over. Sanford-Mayville Hospital is another hospital that serves the community in an 18 mile radius. | ||
| Part VI, Line 5: The mission of the Hillsboro Medical Center is to provide quality health care and living services with dignity and individualized care. Hillsboro Medical Center provides community meetings about CPR, Advance Directives, Child Passenger Safety, Alzheimer's, etc. to promote information and well-being to people in our community. Hillsboro Medical Center also provides a room for Hospice and UND Journal Club free of charge so they can conduct their meetings for the care of people in the community and surrounding areas. The majority of the organization's governing body is comprised of individuals who reside in the primary service area. These individuals are not employees, nor contractors or family members of the organization. The organization extends medical staff privileges to qualified physicians in the community. Surplus funds, if available, are re-invested in the facility to improve patient care. | ||
| Part VI, Line 6: n/a |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Traill County | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 456002246 | IssuerEIN |
| CUSIP Number | 892846AQ9 | CUSIPNumber |
| Date Issued | 2007-05-22 | DateIssued |
| Issue Price | 13341133 | IssuePrice |
| Description Of Purpose | Exp of facility; new Asst Lvg and LT Care bldgs, 80% rmdl of Hospital | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amount Retired | 730000 | AmountRetired |
| Total Proceeds | 13341133 | TotalProceeds |
| Amount In Reserve Fund | 893789 | AmountInReserveFund |
| Capitalized Interest | 658284 | CapitalizedInterest |
| Issuance Costs From Proceeds | 239850 | IssuanceCostsFromProceeds |
| Capital Expenditures | 11549210 | CapitalExpenditures |
| Year Of Subst Completion | 2009 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 0 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | 0 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 0 | ExceptionToRebate |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 1 | The Organization has an Executive Committee which has the power to transact all regular business of the Organization during the interim between meetings of the Board of Directors, provided that any action taken does not conflict with the policies and expressed wishes of the Board and that the Executive Committee refers all matters of major importance to the full Board. The Executive Committee consists of the Chairperson, Vice Chairperson, Corporation CEO/Administrator, Treasurer and Secretary. The Executive Committee is chaired by the Chairperson and meets on call of the Chairperson of the Board or Corporation CEO/Administrator. | |
| Form 990, Part VI, Section A, line 3 | The CEO/Administrator is employed through a management agreement with Sanford Health, an unrelated party. | |
| Form 990, Part VI, Section B, line 11 | The Chief Executive Officer/Administrator will review a draft of the Form 990. During a board meeting, the Board of Directors also received, reviewed, and approved a copy of the Form 990 prior to it being filed. | |
| Form 990, Part VI, Section B, line 12c | The conflict of interest policy covers the Board of Directors. In December, board members are asked to disclose any possible conflicts. The Chief Executive Officer/Administrator reviews the disclosures and determines if there are any conflicts. Any board member with a conflict is asked to abstain from voting on that issue. The conflict of interest for the CEO is covered by the management contract with Sanford Health. The CFO is not covered by the conflict of interest policy. | |
| Form 990, Part VI, Section B, line 15 | Salary range for the CEO is determined by Sanford Health and presented to Hillsboro Medical Center board of trustees for approval. Market comparability data is used to help determine the salary range. The Hospital documents the compensation deliberation and decision for the CEO in the board minutes. The CEO is considered a common law employee of Hillsboro Medical Center and the CFO is considered a common law employee of Sanford Health. Other officer's salaries are reviewed on an annual basis with comparative data. Market adjustments as well as annual increases are approved by the board. This was last completed in December of 2011. | |
| Form 990, Part VI, Section C, line 19 | The governing documents, conflict of interest policy and financial statements are available upon request. | |
| Form 990, Part VII | Ed Laxdal devotes 1 hour per week to the related organization, Hillsboro Medical Center Foundation. | |
| Form 990, Part XI, line 5: | Net unrealized losses on investments: -42,312. | Changes in Net Assets or Fund Balances: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hillsboro Medical Center Foundation | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 609 | AddressLine1 |
| City | Hillsboro | City |
| State | ND | State |
| ZIP Code | 58045 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363542187 | EIN |
| Primary Activities | Fundraising | PrimaryActivities |
| Legal Domicile State | ND | LegalDomicileState |
| Exempt Code Section | 501(c)(3) | ExemptCodeSection |
| Public Charity Status | 7 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hillsboro Medical Center | 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 | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| 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 | 1 | 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
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hillsboro Medical Center Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionType |
| Amount Involved | 443386 | AmountInvolved |
| Method Of Amt Determination | General Ledger | MethodOfAmtDetermination |
Comments