RICHARDTON HEALTH CENTER INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
RICHARDTON HEALTH CENTER INC (EIN 45-0408291)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-02-05
IRS object ID
201340369349300914
Schema version
2011v1.2
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

FieldValueIRS element (for citing)
Timestamp2013-02-05T11:23:58-06:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN450250958EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14310 17TH AVE S PO BOX 2545AddressLine1
CityFARGOCity
StateNDState
ZIP Code581082545ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN450408291EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1RICHARDTON HEALTH CENTER INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlRICHNameControl
Phone7019743304Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX HAddressLine1
CityRICHARDTONCity
StateNDState
ZIP Code586520908ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameGERRY LEADBETTERName
TitleADMINISTRATORTitle
Phone7019743304Phone
Date Signed2013-02-04DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLISA CHAFFEEName
PTINP00193453PTIN
Phone7012398500Phone
Date Prepared2013-02-04DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonGERRY LEADBETTERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX HAddressLine1
CityRICHARDTONCity
StateNDState
ZIP Code586520908ZIPCode
FieldValueIRS element (for citing)
Gross Receipts2194619GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1969YearFormation
State Legal DomicileNDStateLegalDomicile
Activity Or Mission DescriptionTO CREATE & HELP CUSTOMERS BY PROVIDING THE VERY BEST CARE TO PEOPLE IN OUR FACILITY & COMMUNITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees71TotalNbrEmployees
Total Nbr Volunteers45TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year305804ContributionsGrantsPriorYear
Contributions Grants Current Year573823ContributionsGrantsCurrentYear
Program Service Revenue Prior Year1739429ProgramServiceRevenuePriorYear
Program Service Revenue CY1582541ProgramServiceRevenueCY
Investment Income Prior Year334InvestmentIncomePriorYear
Investment Income Current Year312InvestmentIncomeCurrentYear
Other Revenue Prior Year850OtherRevenuePriorYear
Other Revenue Current Year37943OtherRevenueCurrentYear
Total Revenue Prior Year2046417TotalRevenuePriorYear
Total Revenue Current Year2194619TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY574GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year1248165SalariesEtcPriorYear
Salaries Etc Current Year955817SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year587192OtherExpensePriorYear
Other Expenses Current Year1079412OtherExpensesCurrentYear
Total Expenses Prior Year1835357TotalExpensesPriorYear
Total Expenses Current Year2035803TotalExpensesCurrentYear
Revenues Less Expenses Prior Year211060RevenuesLessExpensesPriorYear
Revenues Less Expenses CY158816RevenuesLessExpensesCY
Total Assets BOY1423344TotalAssetsBOY
Total Assets EOY1563712TotalAssetsEOY
Total Liabilities BOY523204TotalLiabilitiesBOY
Total Liabilities EOY506383TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY900140NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1057329NetAssetsOrFundBalancesEOY
Mission DescriptionTO CREATE AND HELP CUSTOMERS BY PROVIDING THE VERY BEST CARE TO THE PEOPLE IN OUR FACILITY AND COMMUNITY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense1811833Expense
Grants574Grants
Revenue1582541Revenue
DescriptionRICHARDTON HEALTH CENTER PROVIDES HIGH QUALITY CLINIC HEALTHCARE AND SKILLED NURSING CARE SERVICES TO RICHARDTON AND THE SURROUNDING AREA. THIS INCLUDES RESPITE CARE, ACUTE INPATIENT CARE, CARDIAC REHAB, PT, OT, ST, A FREE STANDING RURAL HEALTH CLINIC AND LONG-TERM CARE FACILITIES.Description
Total Program Service Expense1811833TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109613NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees71NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1GERRY LEADBETTERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7019743304TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX HAddressLine1
CityRICHARDTONCity
StateNDState
ZIP Code58652ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (12 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
JOHN GENGLER
PRESIDENT (JUL-AUG)1.00XX000
CLAIRE MESSMER
PRESIDENT (AUG-JUN)1.00XX000
JEROME MESSMER
VICE PRESIDENT (AUG-JUN)1.00XX000
VICKIE SOLEMSAAS
TREASURER1.00XX000
DONNA REICH
SECRETARY1.00XX000
ROBERTA FANDRICH
DIRECTOR4.00X000
JEAN BUTTERFIELD
DIRECTOR (JUL-FEB)0.50X000
KATHY HUESKE
DIRECTOR0.50X000
MICHAEL TAFFE OSB
DIRECTOR0.50X000
STEVE MAERSHBECKER
DIRECTOR (DEC-JUN)0.50X000
LYNN BLAKEMAN
ADMINISTRATOR (JUL-APR)40.00X7636506930
GERRY LEADBETTER
ADMINISTRATOR (MAY-JUN)40.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org76365TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation6930TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DAKOTA TRAVEL NURSE INCBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1502 WEST MAIN STREETAddressLine1
CityMANDANCity
StateNDState
ZIP Code58554ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesCONTRACTED NURSINGDescriptionOfServices
Compensation239469Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Government Grants136698GovernmentGrants
All Other Contributions437125AllOtherContributions
Total Contributions573823TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE REVENU62140015722951572295
OTHER REVENUE9000991024610246
FieldValueIRS element (for citing)
Total Program Service Revenue1582541TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column117TotalRevenueColumn
Exclusion$117ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other195Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other195Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column195TotalRevenueColumn
Exclusion$195ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
GAIN ON DEBT FORGIVENE90009936000$36,000
AUXILIARY REVENUE9000991943$1,943
FieldValueIRS element (for citing)
Total Other Revenue37943TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column2194619TotalRevenueColumn
Related Or Exempt Function Income1582541RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$38,255ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total574Total
Program Services574ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total68670Total
Management And General68670ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total39368Total
Program Services39368ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total723496Total
Program Services674772ProgramServices
Management And General48724ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total57200Total
Program Services56507ProgramServices
Management And General693ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total67083Total
Program Services58255ProgramServices
Management And General8828ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total63000Total
Management And General63000ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total13767Total
Management And General13767ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total18300Total
Management And General18300ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total539765Total
Program Services539765ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total1312Total
Management And General1312ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total118196Total
Program Services117520ProgramServices
Management And General676ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total4596Total
Program Services4596ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total56467Total
Program Services56467ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total14402Total
Program Services14402ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total5351Total
Program Services5351ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total6039Total
Program Services6039ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total102856Total
Program Services102856ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total18884Total
Program Services18884ProgramServices

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
MEDICAL SUPPLIES9970299702
DUES/SUBSCRIPTIONS44954495
AUXILIARY EXPENSE316316

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total11964Total
Program Services11964ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2035803Total
Program Services1811833ProgramServices
Management And General223970ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY253583BOY
EOY111004EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY169050BOY
EOY119720EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY32153BOY
EOY25189EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY6335BOY
EOY6369EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2419427LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1317997LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY762223BOY
EOY1101430EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY200000BOY
EOY200000EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY1423344BOY
EOY1563712EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY338661BOY
EOY348760EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY1205BOY
EOY1187EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY183338BOY
EOY156436EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY523204BOY
EOY506383EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY900140BOY
EOY1057329EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY900140BOY
EOY1057329EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1423344BOY
EOY1563712EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses158816ReconcilationRevenueExpenses
Reconcilation Other Changes-1627ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years179843CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1021354CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years535920CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year305804CurrentTaxYearMinus1Year
Current Tax Year573823CurrentTaxYear
Total2616744Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1848277CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1965233CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1520386CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1740279CurrentTaxYearMinus1Year
Current Tax Year1582541CurrentTaxYear
Total8656716Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2028120CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2986587CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2056306CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2046083CurrentTaxYearMinus1Year
Current Tax Year2156364CurrentTaxYear
Total11273460Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years351107CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year926099CurrentTaxYearMinus1Year
Current Tax Year903580CurrentTaxYear
Total2180786Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years351107CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year926099CurrentTaxYearMinus1Year
Current Tax Year903580CurrentTaxYear
Total2180786Total
FieldValueIRS element (for citing)
Public Support Total5099092674PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2671CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years718CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years370CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year334CurrentTaxYearMinus1Year
Current Tax Year117CurrentTaxYear
Total4210Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2671CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years718CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years370CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year334CurrentTaxYearMinus1Year
Current Tax Year117CurrentTaxYear
Total4210Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years204640CurrentTaxYearMinus2Years
Current Tax Year36000CurrentTaxYear
Total240640Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2030791CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2987305CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2261316CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2046417CurrentTaxYearMinus1Year
Current Tax Year2192481CurrentTaxYear
Total11518310Total
FieldValueIRS element (for citing)
Public Support Percentage5090.78940PublicSupportPercentage509
Prior Year Support Percentage0.86570PriorYearSupportPercentage
Investment Income Percentage0.00040InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00050PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc1AgentTrusteeEtc
Beginning Balance1160BeginningBalance
Additions During Year1943AdditionsDuringYear
Distributions During Year316DistributionsDuringYear
Ending Balance2787EndingBalance
Included On FS1IncludedOnFS

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1509813OtherCostOrOtherBasis
Depreciation765248Depreciation
Book Value744565BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis647105OtherCostOrOtherBasis
Depreciation506069Depreciation
Book Value141036BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis262509OtherCostOrOtherBasis
Depreciation46680Depreciation
Book Value215829BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1101430TotalOfBookValueLandBuildings

Other Assets OtherAssets

FieldValueIRS element (for citing)
DescriptionBED LICENSESDescription
Book Value200000BookValue
FieldValueIRS element (for citing)
Total Book Value Other Assets200000TotalBookValueOtherAssets
Total Revenue2194619TotalRevenue
Total Expenses2035803TotalExpenses
Excess Or Deficit For Year158816ExcessOrDeficitForYear
Other-$1,627OtherAmount
Total Adjustments-1627TotalAdjustments
Excess Or Deficit Per FS157189ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt2192676TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal2192676RevenueSubtotal
Other Revenues Not Included1943OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt1943RevenueNotRptdOnFinStmt
Total Revenue Per Form9902194619TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt2035487TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal2035487ExpensesSubtotal
Other Expenses Not Included316OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt316ExpensesNotRptdOnFinStmt
Total Expenses Per Form9902035803TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART IV, LINE 1B:RICHARDTON HEALTH CENTER AUXILIARY IS OPERATING UNDER THE EIN OF RICHARDTON HEALTH CENTER, HOWEVER, THE FINANCIAL STATEMENTS ARE NOT INCLUDED IN THE AUDITED FINANCIAL STATEMENTS OF RICHARDTON HEALTH CENTER.
PART IV, LINE 2B:RICHARDTON HEALTH CENTER ACTS AS CUSTODIAN FOR THE FUNDS OF THE NURSING FACILITY RESIDENTS. THESE FUNDS ARE INCLUDED IN CASH AND ACCOUNTS PAYABLE IN THE FINANCIAL STATEMENTS. RESIDENT TRUST FUNDS TOTALED $1,187 AT JUNE 30, 2012.
PART X:THE HEALTH CENTER IS ORGANIZED AS A NORTH DAKOTA NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE HEALTH CENTER IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE HEALTH CENTER IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE HEALTH CENTER HAS DETERMINED IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS. THE HEALTH CENTER BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HEALTH CENTER WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED.DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:
CHANGE IN AUXILIARY ASSETS -1,627.PART XI, LINE 8 - OTHER ADJUSTMENTS:
AUXILIARY REVENUE 1,943.PART XII, LINE 4B - OTHER ADJUSTMENTS:
AUXILIARY EXPENSE 316.PART XIII, LINE 4B - OTHER ADJUSTMENTS:

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonLAURA LEINGANGNamePerson
FieldValueIRS element (for citing)
RelationshipSISTER OF DONNA REICH (BOARD MEMBER)Relationship
Amount Of Transaction39368AmountOfTransaction
Description Of TransactionCOMPENSATION & BENEFITSDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 3IN DECEMBER OF 2011, THE ORGANIZATION CONTRACTED A MANAGEMENT COMPANY, HMS, TO PROVIDE AN ADMINISTRATOR FOR MANAGEMENT SERVICES.
FORM 990, PART VI, SECTION A, LINE 8BTHERE ARE NO COMMITTEES THAT CAN ACT ON BEHALF OF THE GOVERNING BOARD.
FORM 990, PART VI, SECTION B, LINE 11THE ADMINISTRATOR AND BOARD OF DIRECTORS REVIEWED THE FORM 990 PRIOR TO THE FILING OF THE RETURN.
FORM 990, PART VI, SECTION B, LINE 12CTHE CONFLICT OF INTEREST POLICY COVERS THE BOARD, EMPLOYEES AND CONTRACTORS ALIKE. THE ADMINISTRATOR REVIEWS AND DETERMINES IF CONFLICTS EXIST WITH EMPLOYEES AND CONTRACTORS. THE BOARD REVIEWS AND DETERMINES IF CONFLICTS EXIST WITH A BOARD MEMBER. THE BOARD IS RESPONSIBLE FOR MONITORING ITS MEMBERS AND THE BOARD IN REGARDS TO THIS POLICY. IF NEEDED, THEY WILL SEEK LEGAL CONSULTATION. IF A CONFLICT IS DETERMINED THAT INDIVIDUAL WILL ABSTAIN FROM VOTING.
COMPARABILITY DATA IS NOT USED. THE INDEPENDENT BOARD REVIEWED AND APPROVED THE PRIOR ADMINISTRATOR'S COMPENSATION FOR JULY THROUGH DECEMBER 2011. THE DELIBERATION AND DECISION WAS RECORDED. THIS PROCESS WAS LAST UNDERTAKEN IN 2011. IN DECEMBER 2011 THE ORGANIZATION CONTRACTED AN UNRELATED MANAGEMENT COMPANY, HMS, TO PROVIDE THE ADMINISTRATOR MANAGEMENT SERVCIES. HMS SET THE ADMINISTRATOR COMPENSATION BASED ON COMPARABILITY DATA. THE BOARD REVIEWS AND APPROVES THE CONTRACT WITH HMS.
FORM 990, PART VI, SECTION C, LINE 19THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 5:CHANGE IN AUXILIARY ASSETS -1,627. TOTAL TO FORM 990, PART XI, LINE 5: -1,627.CHANGES IN NET ASSETS OR FUND BALANCES:

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