CUYUNA REGIONAL MEDICAL CENTER: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CUYUNA REGIONAL MEDICAL CENTER (EIN 41-1724637)
- Tax period
- 2012-04-01 to 2013-03-31
- Filed
- 2013-11-05
- IRS object ID
- 201343099349301829
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-05T16:11:47-06:00 | Timestamp |
| Tax Period End Date | 2013-03-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420714325 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCGLADREY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 227 W FIRST ST STE 700 | AddressLine1 |
| City | DULUTH | City |
| State | MN | State |
| ZIP Code | 558021919 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-04-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411724637 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LONGVILLE LAKES CLINIC INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | LONG | NameControl |
| Phone | 2185464366 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 180 JORDAN LANE | AddressLine1 |
| City | LONGVILLE | City |
| State | MN | State |
| ZIP Code | 56655 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KYLE BAUER | Name |
| Title | CFO | Title |
| Phone | 2185464366 | Phone |
| Date Signed | 2013-10-23 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JULIE BOYER | Name |
| PTIN | P01278549 | PTIN |
| Phone | 2187275025 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | KYLE BAUER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 180 JORDAN LANE | AddressLine1 |
| City | LONGVILLE | City |
| State | MN | State |
| ZIP Code | 56655 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 541777 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1992 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE PRIMARY MEDICAL CARE TO RESIDENTS OF THE LONGVILLE AREA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 18 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 18 | NbrIndependentVotingMembers |
| Total Nbr Employees | 13 | TotalNbrEmployees |
| Total Nbr Volunteers | 19 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 21525 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 31546 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 521421 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 510135 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 78 | InvestmentIncomePriorYear |
| Investment Income Current Year | 96 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 543024 | TotalRevenuePriorYear |
| Total Revenue Current Year | 541777 | 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 | 287756 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 320741 | 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 | 486162 | OtherExpensePriorYear |
| Other Expenses Current Year | 499495 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 773918 | TotalExpensesPriorYear |
| Total Expenses Current Year | 820236 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -230894 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -278459 | RevenuesLessExpensesCY |
| Total Assets BOY | 278256 | TotalAssetsBOY |
| Total Assets EOY | 264541 | TotalAssetsEOY |
| Total Liabilities BOY | 197234 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 161978 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 81022 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 102563 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PROVIDE PRIMARY MEDICAL CARE TO RESIDENTS OF THE LONGVILLE AREA. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 750099 | Expense |
| Revenue | 510135 | Revenue |
| Description | THE CARE TEAM AT LONGVILLE LAKES CLINIC PROVIDES A WIDE RANGE OF FAMILY MEDICINE FROM PREVENTATIVE HEALTH SERVICES TO CHRONIC DISEASE MANAGEMENT. IN A STYLE THAT , MORE THAN EVER, REFLECTS LONGVILLE'S UNIQUE SENSE OF COMMUNITY. THE CLINIC IS AVAILABLE FIVE DAYS A WEEK.LONGVILLE LAKES CLINIC PROVIDES THE COMMUNITY WITH A VARIETY OF ADVANCED TREATMENTS AND SUPPORT, AS WELL AS REFERRAL OPTIONS TO MEET MORE SPHISICATED MEDICAL NEEDS.ON MARCH 28, 2010, LONGVILLE LAKES CLINIC BECAME A CERTIFIED RURAL HEALTH CLINIC. | Description |
| Total Program Service Expense | 750099 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | 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 | 0 | Hospital |
| 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 | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 13 | 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 | 18 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 18 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 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 | 0 | CompensationProcessCEO |
| Compensation Process Other | 1 | 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 | KYLE BAUER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2185467000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 320 EAST MAIN ST | AddressLine1 |
| City | CROSBY | City |
| State | MN | State |
| ZIP Code | 56441 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| EARL W BEDARD | ||||||
| CLERK | 1.00 | X | X | 0 | 8225 | 0 |
| MYRON MIDTHUN | ||||||
| TREASURER | 1.00 | X | X | 0 | 5200 | 0 |
| THEODORA SKATTUM | ||||||
| DIRECTOR | 1.00 | X | 0 | 2000 | 0 | |
| ROGER TWIGG | ||||||
| CHAIRMAN | 1.00 | X | X | 0 | 5800 | 0 |
| RUTH HANSEN | ||||||
| DIRECTOR | 1.00 | X | 0 | 2900 | 0 | |
| DANNO MAHONEY | ||||||
| DIRECTOR | 1.00 | X | 0 | 900 | 0 | |
| MARY ZILLMER | ||||||
| DIRECTOR | 1.00 | X | 0 | 1900 | 0 | |
| MIKE VANHORN | ||||||
| DIRECTOR | 1.00 | X | 0 | 2000 | 0 | |
| BETTY PLATISHA | ||||||
| DIRECTOR | 1.00 | X | 0 | 3100 | 0 | |
| ANDREA BEDARD | ||||||
| DIRECTOR | 1.00 | X | 0 | 2600 | 0 | |
| HARRY GOTTSCH | ||||||
| VICE CHAIR | 1.00 | X | X | 0 | 3500 | 0 |
| BRIAN DOBSON | ||||||
| DIRECTOR | 1.00 | X | 0 | 1600 | 0 | |
| JOLIENNE LUNDQUIST | ||||||
| DIRECTOR | 1.00 | X | 0 | 2500 | 0 | |
| AL EBNET | ||||||
| DIRECTOR | 1.00 | X | 0 | 2100 | 0 | |
| DAVE KAUPHUSMAN | ||||||
| DIRECTOR | 1.00 | X | 0 | 2100 | 0 | |
| FLOYD HALE | ||||||
| DIRECTOR | 1.00 | X | 0 | 2500 | 0 | |
| RICHARD SCHILLER | ||||||
| DIRECTOR | 1.00 | X | 0 | 1600 | 0 | |
| KATHY PIERSON | ||||||
| DIRECTOR | 1.00 | X | 0 | 300 | 0 | |
| NANCY MORITZ | ||||||
| DIRECTOR | 1.00 | X | 0 | 2500 | 0 | |
| KYLE BAUER | ||||||
| CFO | 40.00 | X | 0 | 152000 | 31269 | |
| THERESA SULLIVAN | ||||||
| CEO | 40.00 | X | 0 | 122000 | 27393 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 327325 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 58662 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRAL LAKES MEDICAL CLINIC | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 318 MAIN STREET | AddressLine1 |
| City | CROSBY | City |
| State | MN | State |
| ZIP Code | 56441 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | PHYSICIAN SERVICES | DescriptionOfServices |
| Compensation | 199831 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| All Other Contributions | 31546 | AllOtherContributions |
| Total Contributions | 31546 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT REVENUE | Description |
| Business Code | 621500 | BusinessCode |
| Total Revenue Column | 510135 | TotalRevenueColumn |
| Related Or Exempt Function Income | 510135 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 510135 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 96 | TotalRevenueColumn |
| Exclusion | $96 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 541777 | TotalRevenueColumn |
| Related Or Exempt Function Income | 510135 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $96 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 275743 | Total |
| Program Services | 275743 | ProgramServices |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10383 | Total |
| Program Services | 10383 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12812 | Total |
| Program Services | 12812 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21803 | Total |
| Program Services | 21803 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 325092 | Total |
| Program Services | 274236 | ProgramServices |
| Management And General | 50856 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 64377 | Total |
| Program Services | 64377 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 48424 | Total |
| Program Services | 41224 | ProgramServices |
| Management And General | 7200 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6955 | Total |
| Program Services | 6955 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22121 | Total |
| Program Services | 22121 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4829 | Total |
| Program Services | 4829 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MINNESOTA CARE TAX | 7365 | 7365 | |
| PROVISION FOR DOUBTFUL | 6553 | 6553 | |
| DUES & SUBSCRIPTIONS | 6476 | 6476 | |
| PUBLIC RELATIONS | 5528 | 5528 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1775 | Total |
| Program Services | 1775 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 820236 | Total |
| Program Services | 750099 | ProgramServices |
| Management And General | 70137 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50421 | BOY |
| EOY | 24008 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 97814 | BOY |
| EOY | 76341 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4862 | BOY |
| EOY | 7685 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2131 | BOY |
| EOY | 2333 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 361849 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 207675 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 123028 | BOY |
| EOY | 154174 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 278256 | BOY |
| EOY | 264541 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28090 | BOY |
| EOY | 33428 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 169144 | BOY |
| EOY | 128550 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 197234 | BOY |
| EOY | 161978 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 81022 | BOY |
| EOY | 102563 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 81022 | BOY |
| EOY | 102563 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 278256 | BOY |
| EOY | 264541 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -278459 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 300000 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 21605 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 25131 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 12442 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 21525 | CurrentTaxYearMinus1Year |
| Current Tax Year | 31546 | CurrentTaxYear |
| Total | 112249 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 462333 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 470924 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 451493 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 521421 | CurrentTaxYearMinus1Year |
| Current Tax Year | 510135 | CurrentTaxYear |
| Total | 2416306 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 483938 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 496055 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 463935 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 542946 | CurrentTaxYearMinus1Year |
| Current Tax Year | 541681 | CurrentTaxYear |
| Total | 2528555 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 2528555 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 223 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 83 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 59 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 78 | CurrentTaxYearMinus1Year |
| Current Tax Year | 96 | CurrentTaxYear |
| Total | 539 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 223 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 83 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 59 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 78 | CurrentTaxYearMinus1Year |
| Current Tax Year | 96 | CurrentTaxYear |
| Total | 539 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 484161 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 496138 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 463994 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 543024 | CurrentTaxYearMinus1Year |
| Current Tax Year | 541777 | CurrentTaxYear |
| Total | 2529094 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.99980 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.99970 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00020 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.00030 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
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
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 361849 | OtherCostOrOtherBasis |
| Depreciation | 207675 | Depreciation |
| Book Value | 154174 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 154174 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO CUYUNA RANGE HOSPITAL DISTRICT | Description |
| Amount | $128,550 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 128550 | TotalOfAmounts |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | KYLE BAUER | NamePerson |
| Title | CFO | Title |
| Base Compensation Filing Org | 0 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 152000 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 0 | BonusFilingOrg |
| Bonus Related Orgs | 0 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 0 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 0 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 11657 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 0 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 19612 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 0 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 183269 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (4 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| JANEL KAUPSHMANN | |||
| WIFE OF DAVID KAUPSHMAN, DIRECTOR | 84299 | EMPLOYMENT | 0 |
| BOBBIE MIDTHUN | |||
| DAUGHTER IN LAW OF MYRON MIDTHRUN, DIRECTOR | 44943 | EMPLOYMENT | 0 |
| (no name) | |||
| 0 | |||
| CARLA CARLSON | |||
| SISTER IN LAW OF ANDREA BEDARD, DIRECTOR | 32995 | EMPLOYMENT | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | SECTION 3.2 NUMBER OF DIRECTORS. THE BOARD OF DIRECTORS WILL CONSIST OF THE DULY ELECTED DIRECTORS OF THE CUYUNA RANGE HOSPITAL DISTRICT D/B/A CUYUNA REGIONAL MEDICAL CENTER, A HOSPITAL DISTRICT WITHIN MINNESOTA STATUTES, CHAPTER 447, ("HOSPITAL DISTRICT"). PURSUANT TO THE PROVISIONS OF MINNESOTA STATUTES, SECTIONS 447.31 TO 447.37, INCLUSIVE, AS AMENDED, THERE SHALL BE ELECTED FROM EACH CITY OR TOWN COMPRISING THE HOSPITAL DISTRICT ONE DIRECTOR, AND IN ADDITION THERETO THERE SHALL BE, PURSUANT TO THE PROVISIONS OF LAW, ONE DIRECTOR ELECTED AT LARGE. SECTION 3.3 TERMS. A DIRECTOR'S TERM OF OFFICE IS FOUR (4) YEARS COMMENCING ON THE FIRST MONDAY IN JANUARY AND UNTIL A SUCCESSOR QUALIFIES. SECTION 3.4 ATTENDANCE. THE BOARD MAY REMOVE ANY BOARD MEMBER WHO IS ABSENT FROM THE CORPORATION BOARD MEETINGS FOR THREE CONSECUTIVE MONTHS, IF THE BOARD DETERMINES THAT THE MEMBER HAS ABANDONED THE OFFICE. IN THE EVENT OF SUCH A REMOVAL, A MAJORITY OF THE BOARD SHALL APPOINT A SUCCESSOR TO HOLD OFFICE UNTIL THE FIRST MONDAY IN JANUARY AFTER THE NEXT REGULAR HOSPITAL DISTRICT ELECTION. AT THE ELECTION A SUCCESSOR MUST BE ELECTED TO FILL THE UNEXPIRED TERM, REGARDLESS OF WHETHER THE REMOVED MEMBER'S TERM WOULD OTHERWISE HAVE CONTINUED PAST THAT ELECTION DATE. SECTION 3.5 VACANCIES. IF A BOARD MEMBER DIES, RESIGNS, FAILS TO QUALIFY, OR MOVES FROM THE HOSPITAL DISTRICT, A SUCCESSOR SHALL BE APPOINTED BY A MAJORITY OF THE REMAINING MEMBERS OF THE BOARD. THE SUCCESSOR SHALL HOLD OFFICE UNTIL THE FIRST MONDAY IN JANUARY AFTER THE NEXT REGULAR HOSPITAL DISTRICT ELECTION. AT THE ELECTION A SUCCESSOR MUST BE ELECTED TO FILL THE UNEXPIRED TERM REGARDLESS OF WHETHER THE DEPARTING MEMBER'S TERM WOULD OTHERWISE HAVE CONTINUED PAST THE ELECTION DATE. | |
| FORM 990, PART VI, SECTION A, LINE 6 | CUYUNA RANGE HEALTH CORPORATION IS THE SOLE MEMBER OF LONGVILLE LAKES CLINIC. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD OF DIRECTORS CONSISTS OF EIGHTEEN DIRECTORS WHO ARE DESIGNATED BY CUYUNA RANGE HEALTH CORPORATION. | |
| FORM 990, PART VI, SECTION A, LINE 7B | DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY MEMBERS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FINANCE COMMITTEE REVIEWS THE FORM 990 AND SUGGESTS APPROVAL TO THE BOARD. | |
| FORM 990, PART VI, SECTION B, LINE 12C | 1. DUTY TO DISCLOSE: IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. 2. DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS: AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS BY MAJORITY VOTE. 3. PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST: A. AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. B. THE CHAIRPERSON OF THE GOVERNING BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. C. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE ORGANIZATION CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. D. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY UNANIMOUS VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION IT SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. 4. VIOLATIONS OF THE CONFLICTS OF INTEREST POLICY: A. IF THE GOVERNING BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. B. IF, AFTER HEARING THE MEMBER'S RESPONSE AND AFTER MAKING FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE DETERMINES THE MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. RECORDS OF PRECEDINGS: THE MINUTES OF THE GOVERNING BOARD AND ALL COMMITTEES WITH BOARD DELEGATED POWERS SHALL CONTAIN: 1. THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE GOVERNING BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED. 2. THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION WITH THE PROCEEDINGS. COMPENSATION: 1. A VOTING MEMBER OF THE GOVERNING BOARD WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM THE ORGANIZATION FOR SERVICES IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. 2. A VOTING MEMBER OF ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM THE ORGANIZATION FOR SERVICES IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. 3. NO VOTING MEMBER OF THE GOVERNING BOARD OR ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM THE ORGANIZATION, EITHER INDIVIDUALLY OR COLLECTIVELY, IS PROHIBITED FROM PROVIDING INFORMATION TO ANY COMMITTEE REGARDING COMPENSATION. ANNUAL STATEMENTS: EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: 1. HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, 2. HAS READ AND UNDERSTANDS THE POLICY, 3. HAS AGREED TO COMPLY WITH THE POLICY. PERIODIC REVIEWS: TO ENSURE THE ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH PUBLIC HOSPITAL DISTRICT REQUIREMENTS, PERIODIC REVIEWS SHALL BE CONDUCTED. THE PERIODIC REVIEWS SHALL, AT A MINIMUM, INCLUDE THE FOLLOWING SUBJECTS: 1. WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION AND THE RESULT OF ARM'S LENGTH BARGAINING. 2. WHETHER PARTNERSHIPS, JOINT VENTURES AND ARRANGEMENTS WITH MANAGEMENT ORGANIZATIONS CONFORM TO THE ORGANIZATION'S WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE INVESTMENT OR PAYMENTS FOR GOODS AND SERVICES, FURTHER CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT, IMPERMISSIBLE PRIVATE BENEFIT OR IN AN EXCESS BENEFIT TRANSACTION. | |
| FORM 990, PART VI, SECTION B, LINE 15B | THE COMPENSATION FOR KEY EMPLOYEES IS REVIEWED BY THE COMPENSATION COMMITTEE, ALL COMPENSATION IS REVIEWED AGAINST HHRAM AND MMGMA AVERAGES FOR REASONABLENESS. LONGVILLE LAKES CLINIC DOES NOT COMPENSATE ANY TOP MANAGEMENT OFFICIALS. | |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES AND THE FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. | |
| FORM 990, PART IX, LINE 11G | OTHER: PROGRAM SERVICE EXPENSES 274,236. MANAGEMENT AND GENERAL EXPENSES 50,856. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 325,092. | OTHER FEES |
| FORM 990, PART XI, LINE 9: | FORGIVENESS OF DEBT BY CUYUNA RANGE HOSPITAL DISTRICT 300,000. | 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 | CUYUNA REGIONAL MEDICAL CENTER | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 320 E MAIN STREET | AddressLine1 |
| City | CROSBY | City |
| State | MN | State |
| ZIP Code | 56441 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410879376 | EIN |
| Primary Activities | HEALTH CARE | PrimaryActivities |
| Legal Domicile State | MN | LegalDomicileState |
| Exempt Code Section | 115 | ExemptCodeSection |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | 0 | ControlledOrg |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CUYUNA RANGE HEALTH CORP | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 320 EAST MAIN STREET | AddressLine1 |
| City | CROSBY | City |
| State | MN | State |
| ZIP Code | 56441 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411696402 | EIN |
| Primary Activity | HEALTH CARE | PrimaryActivity |
| Legal Domicile State | MN | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CUYUNA RANGE HOSPITAL DISTRICT | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Controlled Org | 0 | 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 | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Comments