KITTSON MEMORIAL HOSPITAL ASSOCIATION: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- KITTSON MEMORIAL HOSPITAL ASSOCIATION (EIN 41-0724034)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-08-15
- IRS object ID
- 201322279349302672
- 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
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-15T12:32:54-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410746749 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410724034 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KITTSON MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | KITT | NameControl |
| Phone | 2188433612 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 700 | AddressLine1 |
| City | HALLOCK | City |
| State | MN | State |
| ZIP Code | 56728 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RICK FAILING | Name |
| Title | CEO/ADMINISTRATOR | Title |
| Phone | 2188433612 | Phone |
| Date Signed | 2013-08-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KURT BENNION | Name |
| PTIN | P01469618 | PTIN |
| Phone | 6123764500 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KITTSON MEMORIAL HEALTHCARE CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | RICK FAILING | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 700 | AddressLine1 |
| City | HALLOCK | City |
| State | MN | State |
| ZIP Code | 56728 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 12928045 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.KHMC.NET | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1919 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | KITTSON ENSURES THAT NORTHWESTERN MINNESOTA RESIDENTS HAVE ACCESS TO HEALTH SERVICES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 272 | TotalNbrEmployees |
| Total Nbr Volunteers | 35 | TotalNbrVolunteers |
| Total Gross UBI | 14749 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 224832 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 220006 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 11921392 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 12667227 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 31823 | InvestmentIncomePriorYear |
| Investment Income Current Year | 21713 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 324565 | OtherRevenuePriorYear |
| Other Revenue Current Year | 14262 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 12502612 | TotalRevenuePriorYear |
| Total Revenue Current Year | 12923208 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 15955 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 1525 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 7061237 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 7600970 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 771 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 4887244 | OtherExpensePriorYear |
| Other Expenses Current Year | 4672174 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 11964436 | TotalExpensesPriorYear |
| Total Expenses Current Year | 12274669 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 538176 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 648539 | RevenuesLessExpensesCY |
| Total Assets BOY | 9765851 | TotalAssetsBOY |
| Total Assets EOY | 11879763 | TotalAssetsEOY |
| Total Liabilities BOY | 4347263 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 5726034 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 5418588 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 6153729 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | CARING FOR FRIENDS AND NEIGHBORS, KITTSON MEMORIAL HEALTHCARE CENTER PROVIDES AND COOPERATES WITH OTHERS TO ENSURE THAT RESIDENTS HAVE ACCESS TO SERVICES NECESSARY TO MAINTAIN THEIR HEALTH AND WELL-BEING. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 9705232 | Expense |
| Grants | 1525 | Grants |
| Revenue | 12668136 | Revenue |
| Description | KITTSON MEMORIAL HEALTHCARE CENTER (KMHC) PROVIDES SERVCE TO EMERGENCY, ACUTE, AND CLINIC PATIENTS. ALL PATIENTS ARE TREATED IN AN EMERGENCY SETTING REGARDLESS OF ABILITY TO PAY OR FINANCIAL CLASS STATUS.KMHC'S NURSING HOME PROVIDES AREA RESIDENTS WITH QUALITY CARE, WHETHER THEIR STAY IS SHORT-TERM OR LONG-TERM. OUR COMPASSIONATE STAFF PROVIDES STIMULATING SOCIAL ACTIVITIES FOR AREA RESIDENTS, AND THE QUALITY OF CARE IS SECOND TO NONE.KMHC PROVIDES MEDICAL AND PERSONAL ASSISTANCE TO THOSE PATIENTS WHO ARE HOME BOUND. THIS VALUED SERVICE PROVIDES AREA RESIDENTS WITH THE ASSISTANCE THEY NEED TO LIVE INDEPENDENTLY WHETHER IT BE HOUSEKEEPING SERVICES, MEDICATION DISPENSION, OR DAILY DRESSING CHANGES.A VOLUNTEER AMBULANCE SERVICE RESPONDS TO EMERGENCY SITUATIONS AS DISPATCHED.KMHC'S ASSISTED LIVING COMPLEX PROVIDES THOSE AREA RESIDENTS WITH OPTIONS TO ASSIST IN THEIR TRANSITION FROM LIVING INDEPENDENTLY TO CONGREGATE DINING WITH OTHER ASSISTED LIVING RESIDENTS, MEDICATION DISPENSION ASSISTANCE, AND ACCESS TO ACTIVITIES IN THE NURSING HOME. RESIDENTS ARE ALSO ABLE TO "COME AND GO" AS THEY PLEASE WITH ACCESS TO THEIR OWN TRANSPORTATION OR TRANSPORTATION MAY BE ARRANGED. | Description |
| Total Program Service Expense | 9705232 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 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 | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 | 1 | 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 | 1 | 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 | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | 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 | 24 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 272 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| 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 | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| 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 | 9 | 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 | 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 | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TODD CHRISTENSEN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2188433612 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1010 SOUTH BIRCH | AddressLine1 |
| City | HALLOCK | City |
| State | MN | State |
| ZIP Code | 56728 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JANELLE CRAIGMILE | |||||||
| BOARD PRESIDENT | 1.00 | X | X | 840 | 0 | 0 | |
| JON BLOMQUIST | |||||||
| BOARD VICE PRESIDENT | 1.00 | X | X | 500 | 0 | 0 | |
| LEE PEMBERTON | |||||||
| BOARD TREASURER | 1.00 | X | X | 950 | 0 | 0 | |
| TODD JOHNSON | |||||||
| BOARD SECRETARY | 1.00 | X | X | 810 | 0 | 0 | |
| JUDY BAHR | |||||||
| BOARD MEMBER | 1.00 | X | 500 | 0 | 0 | ||
| STEVE GROSZ | |||||||
| BOARD MEMBER | 1.00 | X | 250 | 0 | 0 | ||
| CEDRIC GUSTAFSON | |||||||
| BOARD MEMBER | 1.00 | X | 760 | 0 | 0 | ||
| SANDRA NELSON | |||||||
| BOARD MEMBER | 1.00 | X | 300 | 0 | 0 | ||
| MARLENE PEARSON | |||||||
| BOARD MEMBER | 1.00 | X | 250 | 0 | 0 | ||
| RICK FAILING | |||||||
| CEO/ADMINISTRATOR | 40.00 | X | 128619 | 0 | 17484 | ||
| JENI SCHWENZFEIER | |||||||
| CFO | 40.00 | X | 68432 | 0 | 3365 | ||
| THOMAS LOHSTRETER | |||||||
| MEDICAL DOCTOR | 40.00 | 310954 | 0 | 7519 | X | ||
| PAUL ANDERSON | |||||||
| PHYSICIANS ASSISTANT | 40.00 | 148134 | 0 | 18468 | X | ||
| JULIE JOHNSON | |||||||
| NURSE PRACTITIONER | 40.00 | 116027 | 0 | 17401 | X | ||
| JAMES SURDY | |||||||
| MEDICAL DOCTOR | 40.00 | 160024 | 0 | 0 | X | ||
| BRENNA KERR | |||||||
| PHYSICIANS ASSISTANT | 40.00 | 112459 | 0 | 16727 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1049809 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 80964 | TotalOtherCompensation |
| Number Individuals GT100 K | 7 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | 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 |
|---|---|---|---|---|---|
| DMS | |||||
| PO BOX 86 | MINNEAPOLIS | MN | 55486 | MOBILE IMAGING SERVICES | 299824 |
| ALTRU HEALTH SYSTEMS | |||||
| 1300 S COLUMBIA ROAD | GRAND FORKS | ND | 58201 | OUTREACH THERAPY | 230455 |
| PETERSON SHEET METAL | |||||
| 3728 BEMIDJI AVE NORTH | BEMIDJI | MN | 56601 | CONTRACTOR | 149942 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| Fundraising Events | 14383 | FundraisingEvents |
| Government Grants | 131016 | GovernmentGrants |
| All Other Contributions | 74607 | AllOtherContributions |
| Total Contributions | 220006 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT & RESIDENT SER | 622110 | 11810188 | 11810188 | |
| ELECTRONIC HEALTH RECO | 900099 | 784481 | 784481 | |
| MISCELLANEOUS | 900099 | 45096 | 41035 | 4061 |
| CAFETERIA INCOME | 722320 | 27462 | 16774 | 10688 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 12667227 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 21713 | TotalRevenueColumn |
| Exclusion | $21,713 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 12825 | 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 | 12825 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12825 | TotalRevenueColumn |
| Exclusion | $12,825 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 5335 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 14383 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 4837 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 498 | TotalRevenueColumn |
| Exclusion | $498 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 939 | GrossSalesOfInventory |
| Cost Of Goods Sold | 0 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 939 | TotalRevenueColumn |
| Exclusion | $939 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12923208 | TotalRevenueColumn |
| Related Or Exempt Function Income | 12652478 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 14749 | UnrelatedBusinessRevenue |
| Exclusion | $35,975 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1525 | Total |
| Program Services | 1525 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 223060 | Total |
| Program Services | 44612 | ProgramServices |
| Management And General | 178448 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6162442 | Total |
| Program Services | 5130219 | ProgramServices |
| Management And General | 1032223 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 179671 | Total |
| Program Services | 158583 | ProgramServices |
| Management And General | 21088 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 635774 | Total |
| Program Services | 390940 | ProgramServices |
| Management And General | 244834 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 400023 | Total |
| Program Services | 345114 | ProgramServices |
| Management And General | 54909 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3051 | Total |
| Management And General | 3051 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71034 | Total |
| Management And General | 71034 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1402897 | Total |
| Program Services | 1301589 | ProgramServices |
| Management And General | 101308 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16847 | Total |
| Program Services | 7045 | ProgramServices |
| Management And General | 9802 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1590123 | Total |
| Program Services | 1415401 | ProgramServices |
| Management And General | 174722 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 190752 | Total |
| Management And General | 190752 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 283515 | Total |
| Program Services | 26745 | ProgramServices |
| Management And General | 256770 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 116832 | Total |
| Program Services | 88025 | ProgramServices |
| Management And General | 28807 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46064 | Total |
| Program Services | 40947 | ProgramServices |
| Management And General | 5117 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 160214 | Total |
| Program Services | 49646 | ProgramServices |
| Management And General | 110568 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 572430 | Total |
| Program Services | 572430 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 81525 | Total |
| Management And General | 81525 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| BAD DEBT EXPENSE | 117803 | 117803 | ||
| OTHER EXPENSES | 15474 | 14608 | 95 | 771 |
| ADMINISTRATION | 3613 | 3613 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12274669 | Total |
| Program Services | 9705232 | ProgramServices |
| Management And General | 2568666 | ManagementAndGeneral |
| Fundraising | 771 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 711 | BOY |
| EOY | 711 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1439261 | BOY |
| EOY | 1186098 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1052978 | BOY |
| EOY | 2773903 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 87664 | BOY |
| EOY | 151942 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 74824 | BOY |
| EOY | 132193 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43904 | BOY |
| EOY | 56584 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 14345346 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 8191571 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5803878 | BOY |
| EOY | 6153775 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 908271 | BOY |
| EOY | 1378036 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36696 | BOY |
| EOY | 35521 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 317664 | BOY |
| EOY | 11000 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9765851 | BOY |
| EOY | 11879763 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 886950 | BOY |
| EOY | 1580160 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 101227 | BOY |
| EOY | 78192 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3879 | BOY |
| EOY | 8499 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2940271 | BOY |
| EOY | 3337910 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 125000 | BOY |
| EOY | 721273 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 289936 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4347263 | BOY |
| EOY | 5726034 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5418588 | BOY |
| EOY | 6153729 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5418588 | BOY |
| EOY | 6153729 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9765851 | BOY |
| EOY | 11879763 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 648539 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 86602 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $105 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 105 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | THE ORGANIZATION PAYS DUES TO THE MINNESOTA HOSPITAL ASSOCIATION OF WHICH A PORTION IS RELATED TO LOBBYING EXPENSES. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 1 | AgentTrusteeEtc |
| Beginning Balance | 6531 | BeginningBalance |
| Additions During Year | 5440 | AdditionsDuringYear |
| Distributions During Year | 5701 | DistributionsDuringYear |
| Ending Balance | 6270 | EndingBalance |
| Included On FS | 1 | IncludedOnFS |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 12985 | OtherCostOrOtherBasis |
| Book Value | 12985 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9281140 | OtherCostOrOtherBasis |
| Depreciation | 5491966 | Depreciation |
| Book Value | 3789174 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 402009 | OtherCostOrOtherBasis |
| Depreciation | 176041 | Depreciation |
| Book Value | 225968 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4618830 | OtherCostOrOtherBasis |
| Depreciation | 2523564 | Depreciation |
| Book Value | 2095266 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 30382 | OtherCostOrOtherBasis |
| Book Value | 30382 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 6153775 | TotalOfBookValueLandBuildings |
| Total Revenue | 12923208 | TotalRevenue |
| Total Expenses | 12274669 | TotalExpenses |
| Excess Or Deficit For Year | 648539 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 86602 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 86602 | TotalAdjustments |
| Excess Or Deficit Per FS | 735141 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 12680991 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 4837 | OtherRevenues |
| Revenue Not Rptd F990 | 4837 | RevenueNotRptdF990 |
| Revenue Subtotal | 12676154 | RevenueSubtotal |
| Other Revenues Not Included | 247054 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 247054 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 12923208 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 12279506 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 4837 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 4837 | ExpensesNotRptdF990 |
| Expenses Subtotal | 12274669 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 12274669 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART IV, LINE 1B: | A SMALL AUXILIARY OPERATES UNDER THE HOSPITAL'S EIN. | |
| PART IV, LINE 2B: | THE CENTER HOLDS FUNDS UNDER AN AGENCY RELATIONSHIP FOR THE RESIDENTS OF THE NURSING FACILITY. | |
| PART X: | THE CENTER IS ORGANIZED AS A MINNESOTA NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE CENTER UNDERGOES AN ANNUAL ANALYSIS OF ITS VARIOUS TAX POSITIONS, ASSESSING THE LIKELIHOOD OF THESE POSITIONS BEING UPHELD UPON EXAMINATION WITH RELEVANT TAX AUTHORITIES, AS DEFINED BY ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA. THE CENTER BELIEVES THAT IT IS COMPLIANT WITH ALL IRS TAX REGULATIONS AND AS OF SEPTEMBER 30, 2012 AND 2011 HAS NOT RECORDED LIABILITIES FOR INCOME TAXES. THE CENTER WILL RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX LIABILITIES IN INCOME TAX EXPENSE IF INCURRED. THE CENTER IS NO LONGER SUBJECT TO FEDERAL OR STATE TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2009. | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: |
| GOLF TOURNAMENT EXPENSES 4,837. | PART XII, LINE 2D - OTHER ADJUSTMENTS: | |
| INVESTMENT INCOME 21,713. UNRESTRICTED GIFTS AND OTHER 123,643. CONTRIBUTIONS AND GRANTS FOR PROPERTY AND EQUIPMENT 101,698. | PART XII, LINE 4B - OTHER ADJUSTMENTS: | |
| GOLF TOURNAMENT EXPENSES 4,837. | PART XIII, LINE 2D - OTHER ADJUSTMENTS: |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF TOURNAMENT | NameOfEvent1 |
| Gross Receipts Event1 | 19718 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 14383 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 5335 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 604 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 1552 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 988 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 1693 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 19718 | GrossReceiptsTotal |
| Charitable Contributions Total | 14383 | CharitableContributionsTotal |
| Gross Revenue Total Events | 5335 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 604 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 1552 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 988 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 1693 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 4837 | DirectExpenseSummaryEvents |
| Net Income Summary | 498 | NetIncomeSummary |
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 |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent250 | X | Pcent250 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| 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 | 1980 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1980 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1178125 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 999100 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 179025 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01470 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1180105 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 999100 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 181005 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01490 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 19054 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 19054 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00160 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1625445 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1365405 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 260040 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02140 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1644499 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1365405 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 279094 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02300 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2824604 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2364505 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 460099 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03790 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1111 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1111 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1111 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1111 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $117,803 | BadDebtExpenseAmount |
| Amount Attributable To | 7539 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 2721433 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 2721450 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -17 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KITTSON MEMORIAL HEALTHCARE CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1010 SOUTH BIRCH AVENUE | AddressLine1 |
| City | HALLOCK | City |
| State | MN | State |
| ZIP Code | 56728 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KITTSON MEMORIAL HEALTHCARE CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 250.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| 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 | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KITTSON MEMORIAL CLINIC OF KARLSTAD | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | FIRST AND ROOSEVELT | AddressLine1 |
| City | KARLSTAD | City |
| State | MN | State |
| ZIP Code | 56372 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | RURAL HEALTH CLINIC | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 6A: THE ANNUAL COMMUNITY BENEFIT REPORT IS MADE AVAILABLE UPON REQUEST. | |
| PART I, LINE 7: THE ORGANIZATION USED THE FOLLOWING METHODS TO DETERMINE THE COSTS FOR PART I, LINE 7:LINE A - CHARITY CARE WAS CONVERTED TO COST USING THE COST TO CHARGE RATIO FROM THE IRS WORKSHEET 2.LINE B - MEDICAID WAS DERIVED FROM INTERNAL REPORTS AND THEN COSTS WERE CALCULATED USING THE COST TO CHARGE RATIO FROM WORKSHEET 2. LINE E - COMMUNITY HEALTH IMPROVEMENT SERVICES ARE BASED ON THE ACTUAL DOLLARS SPENT FOR THESE ACTIVITIES. LINE G - SUBSIDIZED HEALTH SERVICES ARE DERIVED FROM THE 2012 MEDICARE COST REPORT. | |
| PART I, L7 COL(F): $117,803 OF BAD DEBT EXPENSE WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE COMMUNITY BENEFIT EXPENSE PERCENTAGE FOR FY 2012. | |
| PART II: IN COMPLIANCE WITH KITTSON MEMORIAL HEALTHCARE CENTER'S MISSION TO PROVIDE COMMUNITY SERVICES TO KITTSON COUNTY AND IT'S SURROUNDING COMMUNITIES, FREE CHECK-UPS ARE PROVIDED TO PATIENTS WHO CANNOT AFFORD TO PAY, CHARITY CARE APPLICATIONS ARE AVAILABLE AND APPROVED, AND PUBLIC HEALTH EDUCATION IS PROVIDED. | |
| PART III, LINE 4: BAD DEBT EXPENSE F/S FOOTNOTE IS AS FOLLOWS:PATIENT AND RESIDENT RECEIVABLES ARE UNCOLLATERALIZED CUSTOMER AND THIRD-PARTY PAYOR OBLIGATIONS. PAYMENTS OF PATIENT AND RESIDENT RECEIVABLES ARE ALLOCATED TO THE SPECIFIC CLAIMS IDENTIFIED ON THE REMITTANCE ADVICE OR, IF UNSPECIFIED, ARE APPLIED TO THE EARLIEST UNPAID CLAIM.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.THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN PART III, LINE 2 WAS DERIVED BY APPLYING THE COST TO CHARGE RATIO CALCULATED USING IRS WORKSHEET 2.THE ORGANIZATION ESTIMATES THAT 6.4% OF THE BAD DEBT EXPENSE AT COST IS ATTRIBUTABLE TO PATIENTS WHO WOULD BE ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. APPROXIMATELY 6.4% OF THE POPULATION WHICH THE ORGANIZATION SERVICES IS BELOW FEDERAL POVERTY LEVELS AND SO IT IS REASONABLE TO ASSUME THAT 6.4% OF THE BAD DEBT COULD BE ATTRIBUTABLE TO PATIENTS WHO WOULD BE ELIGIBLE FOR CHARITY CARE. | |
| PART III, LINE 8: MEDICARE ALLOWABLE COSTS ARE BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CMS. | |
| PART III, LINE 9B: COLLECTION EFFORTS ARE MADE BY CONTACTING THE PATIENT THROUGH WRITTEN CORRESPONDENCE AND PHONE CALLS. IF, THROUGHOUT THESE CONVERSATIONS, THE COLLECTOR AND PATIENT DISCUSS THAT THE PATIENT IS NOT ABLE TO AFFORD PAYMENTS AS REQUIRED BY OUR POLICY, THE PATIENT IS ENCOURAGED TO APPLY FOR CHARITY CARE. AN APPLICATION AND POLICY IS SENT TO THE PATIENT TO COMPLETE. ACCORDING TO FEDERAL POVERTY GUIDELINES, THE PATIENT MAY QUALIFY FOR ALL OR A PERCENT OF CHARGES WRITTEN OFF THEIR ACCOUNT. PATIENTS MUST APPLY FOR MEDICAID PRIOR TO QUALIFYING FOR CHARITY CARE. ADDITIONAL INFORMATION IS OFFERED TO HELP THEM APPLY FOR STATE FUNDED PROGRAMS. | |
| PART V, SECTION B, LINE 19D: KMHC CALCULATES AMOUNTS GENERALLY BILLED BASED ON AVERAGE DISCOUNT GIVEN TO ITS LARGEST INSURANCE PROVIDER, BY VOLUME. | KITTSON MEMORIAL HEALTHCARE CENTER |
| PART VI, LINE 2: PUBLIC HEALTH CONDUCTS A COMMUNITY HEALTHCARE NEEDS ASSESSMENT (CHNA). THIS INFORMATION IS THEN SHARED WITH FACILITY MANAGEMENT AND THE BOARD OF DIRECTORS. GOING FORWARD, A CNHA WILL BE CONDUCTED EVERY THREE YEARS TO MAKE THIS ASSESSMENT. | |
| PART VI, LINE 3: IF A PATIENT IS UNABLE TO PAY THEIR BILL, A CHARITY CARE APPLICATION IS SENT TO THEM TO COMPLETE (A NOTICE IS INCLUDED IN THEIR MONTHLY STATEMENT TO CONTACT US REGARDING CHARITY CARE IF THEY ARE UNABLE TO PAY THEIR BILL). A PREREQUISITE TO QUALIFY FOR CHARITY CARE IS THAT THEY HAVE TO HAVE BEEN DENIED BY MEDICAL ASSISTANCE. WE ARE ABLE TO OFFER THEM CONTACT INFORMATION AT THE COUNTY FOR QUALIFICATION/APPLICATION INFORMATION. INFORMATION REGARDING CHARITY CARE IS ALSO AVAILABLE IN THE ADMISSION AREA OF THE CLINIC. | |
| PART VI, LINE 4: KMHC PRIMARILY SERVES THE RESIDENTS OF KITTSON COUNTY, WHICH IS LOCATED IN NORTHWEST MINNESOTA, WITH A POPULATION OF APPROXIMATELY 4,550. THIS IS A VERY RURAL AREA WITH 4.1 PERSONS PER SQUARE MILE. THE MEDIAN HOUSEHOLD INCOME IS $47,568 WITH 6.4% OF THE POPULATION BELOW POVERTY LEVELS. | |
| PART VI, LINE 5: PROVIDE MANAGERS TO DELIVER COMMUNITY MEALS ON WHEELS FOR A MONTH; SPONSOR A TEAM AND FINANCIALLY SUPPORT LOCAL CANCER "RELAY FOR LIFE" EVENT; PROVIDE AMBULANCE STAND-BY SERVICES AT LOCAL PUBLIC HIGH SCHOOL SPORTING VENTS; PROVIDE FREE BLOOD PRESSURE CHECKS AT VARIOUS AREA EVENTS THROUGHOUT THE YEAR; PROVIDE FINANCIAL CONTRIBUTIONS TO HELP FUND TWO AREA PUBLIC SCHOOLS "AFTER PROM PARTY' EVENTS; PROVIDE TO AREA CHARITIES FOR THEIR FUNDRAISING EVENTS, LAB TESTING CERTIFICATES AS DOOR OR RAFFLE PRIZES; FREE AND REDUCED CARE; EVENING MEDICAL CLINIC; HEALTH INFOMRATION BOOTH AT FOUR DAY COUNTY FAIR. ALSO, WE PROVIDE SERVICES THAT NO OTHER PRIVATE ENTITY WOULD LIKELY CONSIDER PROVIDING SUCH AS ASSISTED LIVING SERVICES, NURSING HOME SERVICES, COMMUNITY FITNESS, OR AMBULANCE SERVICES AS THERE IS LITTLE VOLUME AND NOT CURRENTLY FINANCIALLY VIABLE SERVICES. HOWEVER, KITTSON MEMORIAL'S BOARD VIEWS THESE SERVICES AS ESSENTIAL IN METING TH NEEDS OF THE SERVICE AREA'S POPULATION. | |
| PART VI, LINE 6: N/A |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| 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 (3 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THOMAS LOHSTRETER | |||||||||||||
| 244276 | 0 | 66158 | 0 | 520 | 0 | 0 | 0 | 7519 | 0 | 318473 | 0 | 0 | 0 |
| PAUL ANDERSON | |||||||||||||
| 134842 | 0 | 12732 | 0 | 560 | 0 | 0 | 0 | 18468 | 0 | 166602 | 0 | 0 | 0 |
| JAMES SURDY | |||||||||||||
| 128071 | 0 | 31803 | 0 | 150 | 0 | 0 | 0 | 0 | 0 | 160024 | 0 | 0 | 0 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | CHERYL GUSTAFSON | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | SPOUSE OF BOARD MEMBER | Relationship |
| Amount Of Transaction | 26116 | AmountOfTransaction |
| Description Of Transaction | EMPLOYMENT & COMPENSATION | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE (COMPRISED OF THE BOARD OFFICERS) CAN ACT ON BEHALF OF THE FULL BOARD IN CERTAIN CIRCUMSTANCES. | |
| FORM 990, PART VI, SECTION A, LINE 2 | JON BLOMQUIST AND TODD JOHNSON - BUSINESS RELATIONSHIP | |
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBERSHIP IN THE ASSOCIATION SHALL BE ANY NATURAL PERSON OF LEGAL AGE PURCHASING ONE OR MORE MEMBERSHIP SHARES OF THE CORPORATION FOR THE SUM OF $50.00 EACH. | |
| FORM 990, PART VI, SECTION A, LINE 7A | MEMBERS ARE ALLOWED TO VOTE FOR MEMBERS OF THE BOARD AT THE ANNUAL MEETING. | |
| FORM 990, PART VI, SECTION B, LINE 11 | FORM 990 IS REVIEWED WITH THE FULL BOARD PRIOR TO FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | IT IS THE BOARD'S POLICY TO AVOID ANY POSSIBLE APPEARANCE OF IMPROPRIETY OR BREACH OF THE MEMBER'S FIDUCIARY RESPONSIBILITY BY HAVING BOARD MEMBERS ANNUALLY ACKNOWLEDGE ANY POTENTIAL BUSINESS OR PERSONAL CONFLICTS IN REGARDS TO KITTSON MEMORIAL'S BUSINESS AFFAIRS. IT IS NOT THE INTENTION OF THIS POLICY TO PRECLUDE A BOARD MEMBER FROM BEING INVOLVED IN THE DISCUSSION OF A SUBJECT WHERE THE BOARD MEMBER HAS A CONFLICT OF INTEREST. HOWEVER, DISCRETION SHOULD BE EXERCISED AND THE BOARD MEMBER IS EXPECTED TO ABSTAIN FROM VOTING ON THE MATTER. THE CONFLICT OF INTEREST POLICY WILL BE SIGNED ANNUALLY AT THE BOARD'S REGULAR MEETING IN JANUARY. THIS STATEMENT WILL BE RETAINED BY THE PRESIDENT AND A COPY FILED IN THE CEO'S OFFICE. THE PRESIDENT WILL BE RESPONSIBLE TO CALL INTO QUESTION A POSSIBLE CONFLICT OF INTEREST OF A PARTICULAR BOARD MEMBER WHEN APPLICABLE IN THE EVENT THE BOARD MEMBER DOES NOT DECLARE A CONFLICT OF INTEREST. | |
| FORM 990, PART VI, SECTION B, LINE 15A | THE CEO COMPENSATION IS DETERMINED BY STATE SALARY SURVEY DATA AND IS SUBJECT TO BOARD APPROVAL. THE CEO'S CONTRACT WAS REVIEWED IN 2010 AND COMPARED TO THE COMPENSATION DATA FROM MHA, WHICH RESULTED IN AN INCREASE MADE EFFECTIVE OCTOBER 2010. DETERMINATION OF THE CEO'S COMPENSATION LAST INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2012. THE COMPENSATION OF OTHER OFFICERS IS DETERMINED BY THE CEO USING SALARY SURVEY INFORMATION. | |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED GAINS ON INVESTMENTS: 86,602. | CHANGES IN NET ASSETS OR FUND BALANCES: |
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