KITTSON MEMORIAL HOSPITAL ASSOCIATION: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- KITTSON MEMORIAL HOSPITAL ASSOCIATION (EIN 41-0724034)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-07-25
- IRS object ID
- 201132069349300508
- Schema version
- 2009v1.7
- 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 D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-07-25T09:19:31-05:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4310 17TH AVE S PO BOX 2545 | AddressLine1 |
| City | FARGO | City |
| State | ND | State |
| ZIP Code | 581082545 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-10-01 | 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 | 2011-07-18 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | LISA CHAFFEE CPA | Name |
| Phone | 7012398500 | Phone |
| Date Prepared | 2011-07-18 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | 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 | 11771449 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | n/a | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1919 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | To provide hospital services to the sick and injured and to provide nursing care and social activities for the aged in the community. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 271 | TotalNbrEmployees |
| Total Nbr Volunteers | 25 | TotalNbrVolunteers |
| Total Gross UBI | 8771 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -3954 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 66615 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 68042 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 10766684 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 10725366 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 32387 | InvestmentIncomePriorYear |
| Investment Income Current Year | 966436 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 3636 | OtherRevenuePriorYear |
| Other Revenue Current Year | 3756 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 10869322 | TotalRevenuePriorYear |
| Total Revenue Current Year | 11763600 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 11433 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 8251 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 5990859 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 6496286 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 3231 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 4548346 | OtherExpensePriorYear |
| Other Expenses Current Year | 4504547 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 10550638 | TotalExpensesPriorYear |
| Total Expenses Current Year | 11009084 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 318684 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 754516 | RevenuesLessExpensesCY |
| Total Assets BOY | 8653676 | TotalAssetsBOY |
| Total Assets EOY | 9113015 | TotalAssetsEOY |
| Total Liabilities BOY | 4513454 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 4208153 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4140222 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 4904862 | NetAssetsOrFundBalancesEOY |
| 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 | 9771536 | Expense |
| Grants | 8251 | Grants |
| Revenue | 10716595 | Revenue |
| Description | Kittson's exempt purpose is to provide inpatient and outpatient services to individuals residing in the Kittson County area. In addition, the nursing home provides for the physical and social needs of the aged in the community. Services are provided regardless of an individual's ability to pay. The hospital includes a 15-bed acute care hospital and a 70-bed nursing facility. Community benefits provided by the hospital include free physicals to areawide county firemen on an as needed basis. The hospital provided $36,001 of charity care based on the amount of charges foregone. | Description |
| Total Program Service Expense | 9771536 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 1 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| 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 |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 1 | 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 |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 28 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 271 | 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 |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | 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 | 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 | 0 | 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 | Jeni Schwenzfeier | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2188433612 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 700 | 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 |
|---|---|---|---|---|---|---|---|
| Cedric Gustafson | |||||||
| President | 2.00 | X | X | 810 | 0 | 0 | |
| Janelle Craigmile | |||||||
| Vice President | 2.00 | X | X | 771 | 0 | 0 | |
| Lee Pemberton | |||||||
| Treasurer | 2.00 | X | X | 843 | 0 | 0 | |
| Todd Johnson | |||||||
| Secretary | 2.00 | X | X | 670 | 0 | 0 | |
| Heidi Olsonawski | |||||||
| Director (through 1/10) | 1.00 | X | 400 | 0 | 0 | ||
| Judy Bahr | |||||||
| Director | 1.00 | X | 400 | 0 | 0 | ||
| Marlene Pearson | |||||||
| Director | 1.00 | X | 300 | 0 | 0 | ||
| Jon Blomquist | |||||||
| Director | 1.00 | X | 530 | 0 | 0 | ||
| Sandie Nelson | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Richard Failing | |||||||
| CEO/Administrator | 40.00 | X | 38674 | 0 | 3243 | ||
| Jeni Schwenzfeier | |||||||
| CFO (new) | 40.00 | X | 500 | 0 | 0 | ||
| Sandra Gjervold | |||||||
| CFO (Past) | 40.00 | X | 40040 | 0 | 10362 | ||
| Paul Anderson | |||||||
| Phys. Assist. | 40.00 | 142300 | 0 | 21222 | X | ||
| Dr Thomas Lohstreter | |||||||
| Physician | 40.00 | 214500 | 0 | 4860 | X | ||
| Julie Johnson | |||||||
| Nurse Practitioner | 32.00 | 101407 | 0 | 14410 | X | ||
| Alyas Masih | |||||||
| Physician | 40.00 | 212960 | 0 | 10810 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 755105 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 64907 | TotalOtherCompensation |
| Number Individuals GT100 K | 4 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 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 | 554862208 | Mobile Imaging | 255335 |
| Altru Rehab Services | |||||
| 1300 S Columbia Road | Grand Forks | ND | 58201 | Therapy Services | 229233 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| Fundraising Events | 20690 | FundraisingEvents |
| Government Grants | 17749 | GovernmentGrants |
| All Other Contributions | 29603 | AllOtherContributions |
| Total Contributions | 68042 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| Patient & Resident Ser | 622110 | 10608884 | 10608884 | |
| Miscellaneous | 900099 | 64607 | 64607 | |
| Cafeteria Income | 722320 | 24716 | 18597 | 6119 |
| Ambulance Revenue | 621910 | 19259 | 19259 | |
| Auxiliary Revenue | 900099 | 5248 | 5248 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2652 | TotalRevenueColumn |
| Unrelated Business Revenue | 2652 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 10725366 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 52726 | TotalRevenueColumn |
| Exclusion | $52,726 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 8361 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 8361 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8361 | TotalRevenueColumn |
| Exclusion | $8,361 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 915173 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1463 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -1463 | Securities |
| Other | 915173 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 913710 | TotalRevenueColumn |
| Exclusion | $913,710 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 1781 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 20690 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 6386 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -4605 | TotalRevenueColumn |
| Exclusion | -$4,605 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 11763600 | TotalRevenueColumn |
| Related Or Exempt Function Income | 10716595 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 8771 | UnrelatedBusinessRevenue |
| Exclusion | $970,192 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8251 | Total |
| Program Services | 8251 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 242849 | Total |
| Management And General | 242849 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5090438 | Total |
| Program Services | 4924753 | ProgramServices |
| Management And General | 165685 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 127849 | Total |
| Program Services | 122263 | ProgramServices |
| Management And General | 5586 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 584072 | Total |
| Program Services | 401675 | ProgramServices |
| Management And General | 182397 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 451078 | Total |
| Program Services | 355672 | ProgramServices |
| Management And General | 95406 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 93591 | Total |
| Management And General | 93591 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 993759 | Total |
| Program Services | 970665 | ProgramServices |
| Management And General | 23094 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 62733 | Total |
| Program Services | 37223 | ProgramServices |
| Management And General | 25510 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1934612 | Total |
| Program Services | 1548075 | ProgramServices |
| Management And General | 386537 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 79598 | Total |
| Program Services | 79598 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 154853 | Total |
| Program Services | 152748 | ProgramServices |
| Management And General | 2105 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 187974 | Total |
| Program Services | 180797 | ProgramServices |
| Management And General | 7177 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40504 | Total |
| Program Services | 38174 | ProgramServices |
| Management And General | 2330 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 221780 | Total |
| Program Services | 221780 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 542809 | Total |
| Program Services | 542809 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 79284 | Total |
| Program Services | 79284 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Bad Debt Expense | 89039 | 89039 | ||
| Disaster Expense | 16190 | 16190 | ||
| Other Expenses | 6016 | 735 | 2050 | 3231 |
| Auxiliary Expenses | 1805 | 1805 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11009084 | Total |
| Program Services | 9771536 | ProgramServices |
| Management And General | 1234317 | ManagementAndGeneral |
| Fundraising | 3231 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1348056 | BOY |
| EOY | 1345980 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1095170 | BOY |
| EOY | 1120752 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 70056 | BOY |
| EOY | 49069 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 78046 | BOY |
| EOY | 82392 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32883 | BOY |
| EOY | 31174 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 12383967 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 7145932 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4469701 | BOY |
| EOY | 5238035 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1433892 | BOY |
| EOY | 1185644 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 83333 | BOY |
| EOY | 16666 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 42539 | BOY |
| EOY | 43303 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8653676 | BOY |
| EOY | 9113015 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 779388 | BOY |
| EOY | 698280 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 98904 | BOY |
| EOY | 37029 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5243 | BOY |
| EOY | 5433 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3190207 | BOY |
| EOY | 3034133 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 175000 | BOY |
| EOY | 150000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 264712 | BOY |
| EOY | 283278 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4513454 | BOY |
| EOY | 4208153 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4140222 | BOY |
| EOY | 4904862 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4140222 | BOY |
| EOY | 4904862 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8653676 | BOY |
| EOY | 9113015 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 1 | AgentTrusteeEtc |
| Beginning Balance | 5866 | BeginningBalance |
| Additions During Year | 5248 | AdditionsDuringYear |
| Distributions During Year | 1805 | DistributionsDuringYear |
| Ending Balance | 9309 | 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 | 8507967 | OtherCostOrOtherBasis |
| Depreciation | 4836783 | Depreciation |
| Book Value | 3671184 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2549539 | OtherCostOrOtherBasis |
| Depreciation | 2173918 | Depreciation |
| Book Value | 375621 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1313476 | OtherCostOrOtherBasis |
| Depreciation | 135231 | Depreciation |
| Book Value | 1178245 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 5238035 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Deferred compensation | Description |
| Amount | $283,278 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 283278 | TotalOfAmounts |
| Total Revenue | 11763600 | TotalRevenue |
| Total Expenses | 11009084 | TotalExpenses |
| Excess Or Deficit For Year | 754516 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 13567 | NetUnrealizedGLOnInvestments |
| Other | -$3,443 | OtherAmount |
| Total Adjustments | 10124 | TotalAdjustments |
| Excess Or Deficit Per FS | 764640 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 11771919 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 13567 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 13567 | RevenueNotRptdF990 |
| Revenue Subtotal | 11758352 | RevenueSubtotal |
| Other Revenues Not Included | 5248 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 5248 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 11763600 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 11007279 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 11007279 | ExpensesSubtotal |
| Other Expenses Not Included | 1805 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 1805 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 11009084 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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. The resident trust funds totaled $5,433 and $5,243 at September 30, 2010 and September 30, 2009, respectively. | |
| Part X: | The Center is organized as a Minnesota nonprofit corporation and has been recognized by the Internal Revenue Service 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 generally accepted accounting principles. The Center believes that it is compliant with all IRS tax regulations and as of September 30, 2010 and 2009 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 tax examinations by tax authorities for years before 2007 and state examination for years before 2007. | Description of Uncertain Tax Positions Under FIN 48: |
| Part XI, Line 8 - Other Adjustments: | Auxiliary Net Income: -3443. | |
| Part XII, Line 4b - Other Adjustments: | Auxiliary Revenue: 5248. | |
| Part XIII, Line 4b - Other Adjustments: | Auxiliary Expenses: 1805. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Golf Tournament | NameOfEvent1 |
| Gross Receipts Event1 | 20220 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 18439 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 1781 | GrossRevenueEvent1 |
| Other Direct Expenses Event1 | 5778 | OtherDirectExpensesEvent1 |
| Total Number Of Other Events | 1 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 2251 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 2251 | CharitableContribOtherEvents |
| Other Direct Expenses Other Events | 608 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 22471 | GrossReceiptsTotal |
| Charitable Contributions Total | 20690 | CharitableContributionsTotal |
| Gross Revenue Total Events | 1781 | GrossRevenueTotalEvents |
| Other Direct Expenses Total Events | 6386 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 6386 | DirectExpenseSummaryEvents |
| Net Income Summary | -4605 | 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 |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 23 | PersonsServed |
| Total Community Benefit Expense | 31311 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 31311 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00290 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 816477 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 885193 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -68716 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 23 | PersonsServed |
| Total Community Benefit Expense | 847788 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 885193 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -37405 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00290 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 385 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 385 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 703317 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 222250 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 481067 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04410 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1225 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1225 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 704927 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 222250 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 482677 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04420 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 23 | PersonsServed |
| Total Community Benefit Expense | 1552715 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1107443 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 445272 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04710 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1487 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1487 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1487 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1487 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $77,438 | BadDebtExpenseAmount |
| Amount Attributable To | 7744 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 2307580 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 2277284 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 30296 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Critical Access HospitalCriticalAccessHospital | Er24 HoursEr24Hours | OtherOther |
|---|---|---|---|---|---|---|---|---|
| Kittson Memorial Healthcare Center | ||||||||
| 1010 South Birch Avenue | Hallock | MN | 56728 | X | X | X | X | |
| Kittson Memorial Clinic of Karlstad | ||||||||
| First Roosevelt PO Box 199 | Karlstad | MN | 56732 | Rural Health Clinic | ||||
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Income Based Criteria | Part I, Line 3c: Although each application for charity care is dealt with on an individual basis, the following Federal guidelines as to annual income signify a starting point in the eligibility process for discounted care:Poverty Guidelines = Charges reduced to zero150% = 75% reduction in charges200% = 50% reduction in charges250% = 25% reduction in charges | IncomeBasedCriteria |
| Annual Community Benefit Expln | Part I, Line 6a: The annual community benefit report is made available upon request. | AnnualCommunityBenefitExpln |
| Costing Method Used | Part I, Line 7: The organization used the following methods to determine the costs for Part I, Line 7:Row a: Charity care was converted to cost using the cost to charge ratio in worksheet 2.Row b: Medicaid amounts reported reflect amounts calculated from internal records. Row e & i: Community health improvement services and contributions are amounts based on the actual dollars spent in the activities. Row g: Subsidized health services reported are amounts based off of Medicare Cost Report figures. | CostingMethodUsed |
| Percent Of Total Expense Expln | Part I, Line 7f: The amount of bad debt expense removed from the denominator is $89,039. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: Financial Statement Bad Debt Expense Footnote:The carrying amount of patient and resident receivables is reduced by a valuation allowance that reflects management's estimate of amounts that will not be collected from patients, residents, and third-party payors. Management reviews patient and resident receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients and residents due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision.Bad debt expense was converted to cost using the ratio of patient care cost to charges calculated using Worksheet 2.The organization estimates that 10% of the bad debt expense at cost is attributable to patients who would be eligible under the organization's charity care policy. Approximately 10% of population which the organization services is below federal poverty levels and so it is reasonable to assume that 10% of the bad debt could be attributable to patients who would be eligible for charity care. | BadDebtFootnote |
| Shortfall As Community Benefit | 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. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Part III, Line 9b: Collection efforts are made by contacting the patient through written correspondence and via phone. 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 MA prior to qualifying for charity care. Additional information is offered to help them apply for state funded programs. | DebtCollectionPolicy |
| Needs Assessment | Part VI, Line 2: Satisfaction surveys are sent to patients who have had an encounter/visit within the year; community assessments are done every 3-5 years by an independent third party. | NeedsAssessment |
| Patient Education Assistance | 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 applied and 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. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: Kittson Memorial Healthcare Center is the sole provider of healthcare services in Kittson County. We are very rural and struggle with a declining and aging population. The 2010 census shows a population of 4,552. Per capita income is an estimated $24,679, and the median household income is $45,404. Approximately 10% of the population is below the federal poverty level. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: The organization is involved in various community building activities in which they provide community support. The organization donates to the local school for education sessions, to the Hallock Fire Departments for education sessions, to Fair booths and Health Fairs. | CommunityBuildingActivities |
| Other Information | Part VI, Line 6: The governing body consists of residents in our service area who are not employees, contractors, or family members of the organization. The organization continually invests in capital equipment to better the patient experience and services offered. This is difficult to do with limited funds, but every effort is made to continually improve the facility, equipment, and services offered. Medical staff privileges are extended to all qualified physicians in the community.KMHC operates an ER and treats all ER patients, regardless of ability to pay. KMHC also offers scholarship for educational assistance of employees wishing to further enhance their education/career. | OtherInformation |
| Affiliated Health Care System | Part VI, Line 7: N/A | AffiliatedHealthCareSystem |
| Reports Filed With States | MN | ReportsFiledWithStates |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | Scholarships/Educational Assistance | TypeOfGrant |
| Number Of Recipients | 10 | NumberOfRecipients |
| Amount Of Cash Grant | 8251 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: Four scholarships per year are given to one senior in each of the schools located in Kittson County. Educational assistance is provided for employees who choose to further their education in a field that is needed by Kittson Memorial. This eligibility is determined on a case by case basis. | Explanation |
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Paul Anderson | |||||||||||||
| 114855 | 0 | 14537 | 0 | 12908 | 0 | 5000 | 0 | 16254 | 0 | 163554 | 0 | 0 | 0 |
| Dr Thomas Lohstreter | |||||||||||||
| 214500 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 6187 | 0 | 220687 | 0 | 0 | 0 |
| Alyas Masih | |||||||||||||
| 212960 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 12137 | 0 | 225097 | 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 | 20433 | AmountOfTransaction |
| Description Of Transaction | Wages and benefits | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | Committees with authority to act on behalf of governing board: | The Executive Committee has the authroity to act on behalf of the governing board. The committee consists of three individuals: the President, Secretary and Treasurer. The committee did not make any decision on behalf of the full board during the fiscal year. |
| Form 990, Part VI, Section A, line 2 | Jon Blomquist and Todd Johnson have a business relationship. | |
| Form 990, Part VI, Section A, line 6 | There is only one class of members. Stock is purchased for $50/share to obtain membership. | |
| Form 990, Part VI, Section A, line 7a | Members elect the board of directors at the annual meeting. All members have the same voting rights. | |
| Form 990, Part VI, Section A, line 7b | Changes to the bylaws must be approved by the Hospital membership. | |
| Form 990, Part VI, Section B, line 11 | The CEO and CFO will review the Form 990 prior to presenting it at the July 2011 board meeting. | |
| Form 990, Part VI, Section B, line 12c | Only board members are covered by the policy. At the annual January meeting board members are asked to disclose any potential conflicts. The CEO reviews the disclosures and determines if there is a conflict. If a board member is determined to have a conflict they are required to abstain from voting on that particular issue. | |
| 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 contract was reviewed in 2010 and compared to the compensation data from Minnesota Hospital Association (MHA), which resulted in an increase made effective October 2010. The CEO reviews and approves the CFO compensation based on the state salary survey, as well as a performance evaluation. This process was last reviewed and approved in October 2010. | |
| Form 990, Part VI, Section C, line 19 | The governing documents, conflict of interest policy and financial statements are available upon request. |
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