2012-04-13T18:09:27-05:00 2011-06-30 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2010-07-01 450308379 HAZEN MEMORIAL HOSPITAL ASSOCIATION HAZE 7017482225 510 8TH AVENUE NE HAZEN ND 58545 DARROLD BERTSCH 7017482225 2012-04-10 1 LISA CHAFFEE CPA 7012398500 2012-04-10 2010 2016-02-24 21:20:13Z SAKAKAWEA MEDICAL CENTER SENIOR SUI CLINIC SAKAKAWEA HAZEN CLINIC DARROLD BERTSCH 510 8TH AVENUE NE HAZEN ND 58545 10690867 0 X WWW.SAKMEDCENTER.ORG X 1943 ND OPERATION OF A HOSPITAL, CLINIC, AND AN ELDERLY CARE FACILITY. 9 8 166 76 0 0 187816 197868 10090479 10455372 21575 18933 22487 14995 10322357 10687168 2000 2400 0 0 5431615 5765384 0 0 0 4525423 4831338 9959038 10599122 363319 88046 6685642 6438758 2650878 2259583 4034764 4179175 X PROVIDE HIGH QUALITY CARE THAT IS MEASURED AND CONTINUOUSLY IMPROVED. PROVIDE INDIVIDUALIZED CARE THAT EXCEEDS EXPECTATIONS OF THOSE WE SERVE. STRENGTHEN PARTNERSHIPS WITH PROVIDERS TO ENHANCE COORDINATION OF CARE AND IMPROVE SYSTEM PERFORMANCE. BE A STEWARD OF RESOURCES. COMMIT TO SERVICE EXCELLENCE. BE A VITAL CONTRIBUTOR TO OUR AREA COMMUNITIES. RECOGNIZE THE VALUE OF EACH EMPLOYEE AND PROVIDE OPPORTUNITIES FOR PERSONAL GROWTH AND DEVELOPMENT THAT COMPLEMENT THE NEEDS OF THE ORGANIZATION. 0 0 7119741 2400 8057184 SAKAKAWEA MEDICAL CENTER (SMC) IS A 25 BED CRITICAL CARE ACCESS HOSPITAL PROVIDING SERVICES IN THE FOLLOWING AREAS - ACUTE CARE, SURGERY, INTERMEDIATE AND SKILLED SWING BED, EMERGENCY ROOM WITH TRAUMA LEVEL IV CERTIFICATION, HOME HEALTH, AND HOSPICE. SERVICES PROVIDED BY THE ANCILLARY DEPARTMENTS INCLUDE PHYSICAL THERAPY, OCCUPATIONAL THERAPY, RADIOLOGY, DIGITAL MAMMOGRAPHY, BONE DENSITY, ULTRASOUND, CT, NUCLEAR MED, MRI, LABORATORY, RESPIRATORY THERAPY, CARDIAC REHAB, EKG, EEG, SLEEP STUDIES, AND THALLIUM STRESS TESTS. (STATEMENT CONTINUES ON SCHEDULE O.)BASED ON CHARGES FOREGONE SAKAKAWEA MEDICAL CENTER PROVIDED $255,715 IN CHARITY CARE. ALSO AVAILABLE TO ALL SELF PAY PATIENTS, REGARDLESS OF FINANCIAL STATUS, IS A 30% DISCOUNT POLICY FOR TIMELY PAYMENTS. SMC IS A PARTICIPATING PROVIDER FOR MEDICARE, MEDICAID, BLUE CROSS BLUE SHIELD AND OTHER INSURANCES.SAKAKAWEA MEDICAL CENTER REACHES OUT TO THE COMMUNITIES IN THE SERVICE AREA THROUGH PROGRAMS SUCH AS SENIOR DAY OUT, GRIEF SUPPORT GROUPS, SMOKING CESSATION CLASSES, OCCUPATIONAL HEALTH, WOMEN'S HEALTH CLASSES, A CHRISTMAS GIVING TREE PROJECT, AND HEALTH CAREER PRESENTATIONS TO HIGH SCHOOLS. WELLNESS SCREENINGS ARE PROVIDED TO AREA SCHOOLS AND BUSINESSES. SMC PROVIDES COMMUNITY EDUCATION PROGRAMS ON REQUESTED TOPICS FREE OF CHARGE. IT IS IMPORTANT FOR SAKAKAWEA MEDICAL CENTER TO SERVE OUR COMMUNITIES BY PROVIDING ALL OF THEIR HEALTH CARE NEEDS. 589651 866609 SENIOR SUITES IS A BASIC CARE FACILITY THAT WAS COMPLETED IN APRIL 1997, IT IS ADJACENT TO SAKAKAWEA MEDICAL CENTER. SENIOR SUITES CAN ACCOMMODATE 34 RESIDENTS WITH SINGLE OR DOUBLE ROOMS. IT FEATURES A LICENSED BEAUTY SHOP, ACTIVITY ROOM, SPACIOUS COMMONS AREAS AND AN ENCLOSED NURSE'S STATION. THE ROOMS ARE SET UP LIKE SUITES, HENCE THE NAME "SENIOR SUITES." THE FACILITY IS AVAILABLE TO THOSE IN THE SENIOR POPULATION THAT REQUIRES A MINIMAL AMOUNT OF SUPERVISION, BUT DO NOT REQUIRE 24 HOUR SERVICES. THE RESIDENTS ARE PROVIDED WITH ASSISTANCE FOR DAILY LIVING AND MEDICATION ADMINISTRATION. 1515980 1531579 TO INSURE THE NEED FOR QUALITY HEALTH CARE IS MET IN SMC'S SERVICE AREA, SAKAKAWEA MEDICAL CENTER BEGAN MANAGING TWO RURAL HEALTH CLINICS IN JULY 2007. ONE CLINIC IS LOCATED IN BEULAH AND ONE IN HAZEN. THIS PROVIDES PRIMARY HEALTH CARE FOR OUR PATIENTS AND ALSO SPACE IS PROVIDED IN THE CLINICS FOR VISITING SPECIALISTS. THIS SAVES THE PATIENTS FROM HAVING TO DRIVE UP TO 70 MILES TO RECEIVE SPECIALTY HEALTH CARE. THE CLINICS ARE STAFFED WITH PHYSICIANS AND MID-LEVEL PROVIDERS. A SLIDING FEE SCALE CHARITY CARE PROGRAM IS AVAILABLE TO PATIENTS WHO QUALIFY FINANCIALLY. 9225372 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 22 0 1 166 1 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 0 1 1 0 0 X RENAE SNYDER 7017482225 510 8TH AVENUE NE HAZEN ND 58545 CHRISTIE OBENAUER 2.00 X X 0 0 0 JAN RUDOLF 1.50 X X 0 0 0 BEVERLY HUBER 1.50 X X 0 0 0 LORI KUSCHEL 1.50 X 0 0 0 LYNN OELKE 1.50 X 0 0 0 MARK GERDE 1.50 X 0 0 0 MYRIA PERRY 1.50 X 0 0 0 SIENNA SAILER 1.50 X 0 0 0 FRED STERN 1.50 X 0 0 0 RICK MILLER 1.50 X 0 0 0 DARROLD BERTSCH 40.00 X 141401 0 15946 RENAE SNYDER 40.00 X 57647 0 2940 RONALD SCHMITZ 40.00 X 204430 0 5401 MICHAEL SCHMIT 40.00 X 266473 0 11745 RODNEY ZIMMERMAN 40.00 X 270997 0 14470 940948 0 50502 4 0 1 0 ST ALEXIUS MEDICAL CENTER PO BOX 5510 BISMARCK ND 58506 MANAGEMENT SERVICES 437380 MONDAK IMAGING 11 SOUTH 7TH ST SUITE 241 MILES CITY MT 59301 MRI SERVICES 196498 DMS IMAGING PO BOX 86 MINNEAPOLIS MN 55486 MEDICAL IMAGING 133774 NORTHERN X-RAY 2118 4TH AVE S MINNEAPOLIS MN 55404 RADIOLOGY MAINTENANCE 106529 4 197868 197868 PATIENT AND RESIDENT S 621400 10303675 10303675 OTHER PROGRAM REVENUE 623000 89685 89685 EDUCATION 623000 43584 43584 CAFETERIA 623000 18428 18428 10455372 18493 18493 8589 8589 8589 8589 3014 2574 440 440 440 7531 1125 6406 6406 10687168 10455372 0 33928 2400 2400 235447 235447 4757900 4459623 298277 141087 30410 110677 291753 78896 212857 339197 303300 35897 33796 33796 1637824 1575037 62787 21251 289 20962 1276605 1121108 155497 412545 412545 29610 20111 9499 61267 17438 43829 490647 490647 95152 23578 71574 BAD DEBT EXPENSE 606739 606739 DUES & SUBSCRIPTIONS 65133 44441 20692 COLLECTIONS EXPENSE 40486 40486 AUXILIARY EXPENSES 10776 10776 RECRUITING 0 49507 28034 21473 10599122 9225372 1373750 0 4410 7762 1582348 1373983 1610880 1335769 268761 299330 35336 23285 8386091 6090418 2325616 2295673 390632 497547 231297 286973 236362 318436 6685642 6438758 1091577 806292 1481162 1357853 78139 95438 2650878 2259583 X 3753467 3842202 231297 286973 50000 50000 4034764 4179175 6685642 6438758 X 88046 56365 X 0 1 0 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 23092 23092 5521544 4150904 1370640 2782609 1892993 889616 58846 46521 12325 2295673 CAPITAL LEASE OBLIGATIONS 95438 95438 10687168 10599122 88046 56365 56365 144411 10625682 0 10625682 61486 61486 10687168 10585946 1125 1125 10584821 14301 14301 10599122 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE MEDICAL CENTER BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE MEDICAL CENTER WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN NET ASSETS OF SAKAKAWEA MEDICAL CENTER FOUNDATION 55,676. CHANGE IN NET ASSETS OF SAKAKAWEA MEDICAL CENTER AUXILIARY 689. PART XII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY REVENUE 13,612. SPECIAL EVENTS EXPENSE RECORDED IN REVENUE ON FORM 990 -1,125. TRANSFER FROM RELATED ORGANIZATION RECORDED IN NET ASSETS FOR FINANCIALS 48,999. PART XIII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENTS EXPENSE RECORDED IN REVENUE ON FORM 990 1,125. PART XIII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY EXPENSES 14,301. 1 1 X 1 X 0 0 1 1 0 0 185223 185223 0.01850 280954 149470 131484 0.01320 466177 149470 316707 0.03170 6875 6875 0.00070 16639 1200 15439 0.00150 820704 789178 31526 0.00320 8663 8663 0.00090 852881 790378 62503 0.00630 1319058 939848 379210 0.03800 0 429868 26652 3457345 3444711 12634 X 1 1 1 1 SAKAKAWEA MEDICAL CENTER

510 8TH AVE NE HAZEN ND 58545

X X X NOT REQUIRED 1 3 SAKAKAWEA HAZEN CLINIC

813 7TH ST NE HAZEN ND 58545

CLINIC SAKAKAWEA BEULAH CLINIC

1101 3RD AVE NW BEULAH ND 58523

CLINIC SENIOR SUITES AT SAKAKAWEA

813 7TH ST NE HAZEN ND 58545

BASIC CARE FACILITY PART I, LINE 3C: SAKAKAWEA MEDICAL CENTER OFFERS TWO SEPARATE PROGRAMS FOR DISCOUNTED CARE.THE SELF PAY DISCOUNT POLICY IS AVAILABLE FOR UNINSURED PATIENTS REGARDLESS OF INCOME. A DISCOUNT OF 30% IS ALLOWED IF REGULAR MONTHLY PAYMENTS ARE REMITTED IN A SPECIFIED TIME FRAME. THIS PROGRAM CANNOT BE COMBINED WITH THE CHARITY CARE PROGRAM.THE CHARITY CARE PROGRAM PROVIDES DISCOUNTED CARE TO PATIENTS BASED ON FAMILY INCOME ACCORDING TO FPG GUIDELINES. THE SLIDING FEE SCALE ALLOWS DISCOUNTS FROM 20% TO 100% OF CHARGES. THE PROGRAM IS AVAILABLE FOR UNINSURED PATIENTS AS WELL AS CO-PAYS AND DEDUCTIBLES FOR INSURED PATIENTS. PART I, LINE 7: CHARITY CARE AND UNREIMBURSED MEDICAID WAS CONVERTED TO COST USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. COMMUNITY HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONALS EDUCATION AND CONTRIBUTIONS REFLECT ACTUAL EXPENSES RECORDED TO THE GENERAL LEDGER. SUBSIDIZED HEALTH SERVICES COSTS WERE CALCULATED BASED ON INFORMATION FROM THE MEDICARE COST REPORT. PART I, LINE 7G: HAZEN MEMORIAL HOSPITAL ASSOCIATION OPERATES TWO RURAL CLINICS WHICH OPERATE AT A LOSS. IF THESE CLINICS DID NOT OFFER THEIR SERVICES IN EACH OF THESE COMMUNITIES THE SERVICE WOULD BE LIMITED IN THE COMMUNITY. PART I, L7 COL(F): FOR THE PURPOSES OF CALCULATING THE PERCENTAGE ON PART 1, LINE F, $606,739 WAS BACKED OUT OF TOTAL OPERATING EXPENSES. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE DESCRIBING BAD DEBT EXPENSE: 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.PAYMENTS AND DISCOUNTS ARE POSTED TO PATIENT BILLS. ANY REMAINING BALANCES ARE BILLED TO THE PATIENT THROUGH MONTHLY STATEMENTS. IF NO PAYMENTS ARE RECEIVED FROM THE PATIENT AT THE END OF THE FOURTH MONTH, THE ACCOUNT IS TURNED OVER TO A COLLECTION AGENCY AND THE BALANCE ON THE ACCOUNT IS WRITTEN OFF AS A BAD DEBT. THE BAD DEBT EXPENSE IS SHOWN ON THE MONTHLY FINANCIAL STATEMENTS.THERE ARE MOST LIKELY SOME PATIENTS IN BAD DEBT WHO WOULD QUALIFY FOR CHARITY CARE, BUT THEY HAVE NOT COMPLETED THE APPLICATION AND REMITTED THE REQUIRED PAYMENT. BASED ON THE POVERTY LEVEL OF THE SERVICE AREA, 6.2%, THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE THAT IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY WOULD BE APPROXIMATELY $26,652. PART III, LINE 8: MEDICARE ALLOWABLE COSTS OF CARE ARE BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CMS. PART III, LINE 9B: IF A PATIENT HAS APPLIED FOR CHARITY CARE PREVIOUSLY, AN APPLICATION IS SENT WITH THE MONTHLY STATEMENT. THE APPLICATION REQUESTING FINANCIAL INFORMATION WAS REQUIRED EACH TIME A NEW BILL WAS INCURRED. THE NEW POLICY EFFECTIVE 7/1/10 REQUIRES A NEW APPLICATION ONLY EVERY SIX MONTHS. PART VI, LINE 2: SAKAKAWEA MEDICAL CENTER CONSULTS WITH LOCAL PHYSICIANS TO SEE WHAT THE COMMUNITY HEALTHCARE NEEDS ARE. THE SMC STAFF PARTICIPATES IN LOCAL AND REGIONAL ORGANIZATIONS AND ACTIVITIES INCLUDING CHAMBER OF COMMERCE AND ECONOMIC DEVELOPMENT BOARDS. THE CEO ROUTINELY ATTENDS CITY COUNCIL AND COUNTY COMMISSION MEETINGS TO SOLICIT INPUT AND ENGAGE IN DIALOGUE RELATING TO HEALTHCARE NEEDS AND SERVICES.SAKAKAWEA MEDICAL CENTER IS COLLABORATING WITH OTHER LOCAL PROVIDERS TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT WHICH WILL INVENTORY SERVICE DELIVERY ASSETS, IDENTIFY NEEDS AND CREATE A FOUNDATION FOR UNDERTAKING STRATEGIC INITIATIVES. PART VI, LINE 3: CHARITY CARE INFORMATION IS SENT WITH THE MONTHLY STATEMENTS TO ALL UNINSURED PATIENTS AS WELL AS PATIENTS THAT ARE NOT MAKING ADEQUATE MONTHLY PAYMENTS. APPROXIMATELY 100 NOTICES ARE SENT OUT PER MONTH WITH THE STATEMENTS. INPATIENTS AND SURGICAL PATIENTS ARE INFORMED AT TIME OF ADMISSION ABOUT CHARITY CARE. A SOCIAL WORKER VISITS WITH ALL SELF PAY INPATIENTS TO INFORM THEM ABOUT THE CHARITY CARE, MEDICAID (STATE PROGRAM), AND SELF PAY DISCOUNT POLICIES. BROCHURES HAVE BEEN PRINTED THAT DESCRIBE OUR CHARITY CARE AND DISCOUNT POLICIES. THE BROCHURES ARE AVAILABLE IN WAITING ROOMS, ER, THE CLINICS AND ADMITTING OFFICES. PART VI, LINE 4: HAZEN MEMORIAL HOSPITAL ASSOCIATION SERVES THE COMMUNITIES IN MERCER COUNTY AND THE SURROUNDING AREA, INCLUDING THE TOWNS OF HAZEN, BEULAH, STANTON, ZAP, GOLDEN VALLEY, CENTER AND PICK CITY. SAKAKAWEA MEDICAL CENTER, LOCATED IN HAZEN, IS THE ONLY HOSPITAL IN THE COUNTY. THE NEAREST HOSPITAL IS LOCATED MORE THAN 60 MILES AWAY. ATTACHED TO THE HOSPITAL IS SENIOR SUITES, A BASIC CARE FACILITY. THE ASSOCIATION MANAGES TWO RURAL HEALTH CLINICS, ONE IN HAZEN AND ONE IN BEULAH. THE COMBINED TOTAL POPULATION OF THE COUNTY IS APPROXIMATELY 8,214. THE AVERAGE ANNUAL WAGE IN MERCER COUNTY FOR 2010 WAS $56,217. THE CURRENT UNEMPLOYMENT RATE IS 3.9%. SAKAKAWEA MEDICAL CENTER'S PAYER MIX FOR THIS FISCAL YEAR INCLUDED 10% UNINSURED PATIENTS AND 5% MEDICAID PATIENTS. ALL PATIENTS PRESENTING TO THE FACILITY ARE CARED FOR REGARDLESS OF THEIR ABILITY TO PAY. PART VI, LINE 6: AS A CRITICAL ACCESS HOSPITAL, SAKAKAWEA MEDICAL CENTER PROVIDES A VARIETY OF HEALTH AND WELLNESS SERVICES TO OUR SERVICE AREA. THE ORGANIZATION SUBSIDIZES PRIMARY CARE SERVICES PROVIDED AT THE SAKAKAWEA BEULAH CLINIC AND THE SAKAKAWEA HAZEN CLINIC, INSURING THAT PRIMARY CARE IS AVAILABLE IN THE LOCAL COMMUNITIES. SMC ALSO SUBSIDIZES HOME HEALTH SERVICES TO INSURE THOSE RESIDENTS WHO ARE HOMEBOUND HAVE THE HEALTH CARE THEY NEED. THE EMERGENCY ROOM IS STAFFED 24 HOURS A DAY AND IS AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY.THE BOARD OF DIRECTORS IS COMPRISED OF COUNTY-WIDE VOLUNTEERS; TWO ARE FROM HAZEN, FIVE FROM BEULAH, ONE FROM PICK CITY AND ONE FROM STANTON. THE DIRECTORS HAVE VARIOUS OCCUPATIONS INCLUDING POWER PLANT MANAGER, BANK VICE PRESIDENT, ACCOUNTING SUPERVISOR, ENGINEER, AND BUSINESS OWNER. THE DIRECTORS ARE NOT EMPLOYED BY SMC NOR ARE THEY FAMILY MEMBERS OF EMPLOYEES.MEDICAL PRIVILEGES ARE EXTENDED TO ALL PHYSICIANS IN THE COUNTY.SAKAKAWEA MEDICAL CENTER'S HOSPICE STAFF IS ASSISTED BY 68 VOLUNTEERS FROM THE AREA COMMUNITIES. THE STAFF AT SENIOR SUITES, THE BASIC CARE FACILITY, IS SERVED BY 10 COMMUNITY VOLUNTEERS. SURPLUS FUNDS ARE INVESTED BACK INTO THE FACILITY THROUGH EQUIPMENT UPGRADES AND BUILDING IMPROVEMENTS. RECENT INVESTMENTS INCLUDE THE PURCHASE OF A NEW CHILLER FOR THE AIR CONDITIONING UNIT, REMODELING THE LAB TO INCLUDE A LARGE PRIVATE BLOOD DRAW AREA, PURCHASE OF THALIUM STRESS EQUIPMENT, PURCHASE OF NEW TELEVISIONS WITH PILLOW SPEAKERS FOR PATIENT CARE AREAS, AND NEW FLOORING, PAINT, AND WINDOWS THROUGHOUT THE FACILITY. IN ADDITION, MORE CONTINUING EDUCATION IS BEING OFFERED TO THE STAFF BY MEANS OF WEBINARS AND WORKSHOPS. AN EMPLOYEE ASSISTANCE PROGRAM IS AVAILABLE FOR STAFF AND FAMILY MEMBERS WHICH PROVIDES FREE CONFIDENTIAL ASSESSMENTS, COUNSELING, OR REFERRAL SERVICES BY TRAINED PROFESSIONALS.SAKAKAWEA MEDICAL CENTER IS INVESTING IN THE FUTURE OF HEALTHCARE PROFESSIONALS BY IMPLEMENTING A NURSING PROGRAM. WE ARE PARTNERING WITH OTHER HEALTH CARE PROVIDERS IN THE COUNTY, A COMMUNITY HEALTH CENTER AND A NURSING HOME, TO OFFER INTERACTIVE VIDEO NETWORK (IVN) CLASSES IN OUR FACILITY. HANDS-ON SKILL WORK AND CLINICALS ARE TAUGHT BY REGISTERED NURSES EMPLOYED BY OUR ORGANIZATION. UPON COMPLETION OF AN 11 MONTH PROGRAM, STUDENTS WILL RECEIVE A CERTIFICATE IN PRACTICAL NURSING. SAKAKAWEA MEDICAL CENTER ALSO SUPPORTS STATE UNIVERSITIES AND HIGH SCHOOLS BY OFFERING RURAL MEDICAL EXPERIENCES TO AREA STUDENTS. THROUGHOUT THE YEAR, STUDENTS ARE PROVIDED WITH PRACTICE OPPORTUNITIES IN NURSING, LAB, PT OR THE EMERGENCY ROOM. X X X 0 0 0 0 0 0 0 0 0 DARROLD BERTSCH 128491 0 12910 0 0 0 1926 0 14071 0 157398 0 0 0 RONALD SCHMITZ 204430 0 0 0 0 0 0 0 11452 0 215882 0 0 0 MICHAEL SCHMIT 242473 0 24000 0 0 0 0 0 11788 0 278261 0 0 0 RODNEY ZIMMERMAN 230997 0 40000 0 0 0 0 0 14521 0 285518 0 0 0 UNION STATE BANK BOND REFINANCE X 663689 517281 0 1 1 UNION STATE BANK SOFTWARE X 350000 163808 0 1 1 UNION STATE BANK NEW BOILERS X 224235 166502 0 1 1 UNION STATE BANK REFINANCE EQUIPMENT X 506000 404741 0 1 1 UNION STATE BANK ULTRASOUND X 138872 105521 0 1 1 1357853 FORM 990, PART VI, SECTION A, LINE 6 ANY PERSON, FIRM, ASSOCIATION, OR CORPORATION INTERESTED IN THE ACTIVITIES OF THIS ORGANIZATION MAY BECOME A MEMBER THEREOF, PROVIDED THAT HE HAS FIRST CONTRIBUTED AT LEAST $10.00 TO THE ASSOCIATION AT SOME TIME, AND FURTHER PROVIDED THAT HE HAS PAID THE ANNUAL MEMBERSHIP DUES HEREINAFTER SPECIFIED. IT IS ALSO AGREED IN THOSE CASES IN WHICH A CONTRIBUTION EQUAL TO OR EXCEEDING $20.00 WAS GIVEN IN THE NAME OF ONE INDIVIDUAL, IF THAT INDIVIDUAL WAS MARRIED AT THE TIME OF THE CONTRIBUTION, BOTH HUSBAND AND WIFE SHALL BE CONSIDERED ELIGIBLE FOR MEMBERSHIP IN THE ASSOCIATION SUBJECT TO PAYMENT OF THE MEMBERSHIP FEE OUTLINED IN ARTICLE I, SECTION 3. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS ELECT THE BOARD OF DIRECTORS ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION A, LINE 8B ALL ITEMS DISCUSSED AT COMMITTEE MEETINGS ARE BROUGHT TO THE FULL BOARD FOR RECOMMENDATIONS FOR BOARD ACTION. THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES THAT HAVE THE AUTHORITY TO ACT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11 UPON RECEIPT OF THE DRAFT FORM 990, A COPY WILL BE FORWARDED TO THE BOARD MEMBERS FOR THEIR REVIEW AND COMMENT. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS IS COVERED BY THE CONFLICT OF INTEREST POLICY. ONLY ONE CONFLICT HAS BEEN DISCLOSED THIS FISCAL YEAR BY A MEMBER OF THE BOARD OF DIRECTORS. THE DIRECTOR WHO HAS ACKNOWLEDGED THE CONFLICT OF INTEREST IS EXCUSED FROM THE BOARD MEETING WHENEVER THERE IS DISCUSSION ABOUT THE RELEVANT ISSUE. FORM 990, PART VI, SECTION B, LINE 15A FOR PURPOSES OF DETERMINING BOTH THE CEO AND THE CFO'S COMPENSATION PACKAGES AT SAKAKAWEA MEDICAL CENTER, A VARIETY OF RESOURCES ARE USED. THE ORGANIZATION TAKES INTO CONSIDERATION WHAT IS APPROPRIATE COMPENSATION FOR THOSE RESPECTIVE POSITIONS, BASED ON THEIR MARKET. THE ORGANIZATION USES SALARY SURVEYS FROM THE NORTH DAKOTA HOSPITAL ASSOCIATION. THEY TAKE INTO CONSIDERATION WHAT RECRUITING FIRMS RECOMMEND TO THE ORGANIZATION FOR TYPICAL COMPENSATION FOR THOSE POSITIONS. THE BOARD OF DIRECTORS EVALUATES THE CEO ONCE PER YEAR AND USES THE ABOVE INFORMATION FOR DETERMINING COMPENSATION. THE CFO IS EVALUATED BY THE CEO YEARLY AND THE COMPENSATION IS BASED ON THE ABOVE INFORMATION. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE IF SPECIFICALLY REQUESTED. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: CHANGE IN INTEREST IN NET ASSETS OF SAKAKAWEA MEDICAL CENTER FOUNDATION 55,676. CHANGE IN NET ASSETS OF SAKAKAWEA MEDICAL CENTER AUXILIARY 689. TOTAL TO FORM 990, PART XI, LINE 5: 56,365. HAZEN MEMORIAL HOSPITAL AUXILIARY 510 8TH AVENUE NE HAZEN ND 58545 450308379 FUNDRAISING FOR HOSPITAL ND 13612 4922 N/A