CAVALIER COUNTY MEMORIAL HOSPITAL ASSOCIATION: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- CAVALIER COUNTY MEMORIAL HOSPITAL ASSOCIATION (EIN 45-0306787)
- Tax period
- 2023-07-01 to 2024-06-30
- Filed
- 2025-03-24
- IRS object ID
- 202520839349300772
- Schema version
- 2023v6.0
- 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 B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-03-24T13:19:54-05:00 | ReturnTs |
| Tax Period End | 2024-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 161131146 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BONADIO & CO LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 171 SULLYS TRAIL | AddressLine1Txt |
| City | PITTSFORD | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14534 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450306787 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAVALIER COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Business Name Line2 | ASSOCIATION | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CAVA | BusinessNameControlTxt |
| Phone | 7012566100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 909 2ND ST | AddressLine1Txt |
| City | LANGDON | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58249 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | WAYNE REID | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7012566100 | PhoneNum |
| Signature | 2025-03-24 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AIMEE JOZIC | PreparerPersonNm |
| PTIN | P01329472 | PTIN |
| Phone | 5853811000 | PhoneNum |
| Preparation | 2025-03-24 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LANGDON PRAIRIE HEALTH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | WAYNE REID | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 909 2ND ST | AddressLine1Txt |
| City | LANGDON | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58249 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,021,254 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTPS://WWW.LPH.HOSPITAL/HOME | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1969 | FormationYr |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Activity Or Mission | LPH IS DEDICATED TO EXCEL AT PROVIDING HIGH-QUALITY, COMPASSIONATE HEALTHCARE TO ALL WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 100 | TotalEmployeeCnt |
| Total Volunteers | 7 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $72,679 | PYContributionsGrantsAmt |
| CY Contributions Grants | $396,122 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $13,848,087 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $13,392,815 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$13,512 | PYInvestmentIncomeAmt |
| CY Investment Income | $45,558 | CYInvestmentIncomeAmt |
| PY Other Revenue | $330,150 | PYOtherRevenueAmt |
| CY Other Revenue | $186,759 | CYOtherRevenueAmt |
| PY Total Revenue | $14,237,404 | PYTotalRevenueAmt |
| CY Total Revenue | $14,021,254 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $9,932 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $7,394 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,016,839 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,125,035 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,099,208 | PYOtherExpensesAmt |
| CY Other Expenses | $8,135,959 | CYOtherExpensesAmt |
| PY Total Expenses | $14,125,979 | PYTotalExpensesAmt |
| CY Total Expenses | $14,268,388 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $111,425 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$247,134 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $18,667,941 | TotalAssetsBOYAmt |
| Total Assets EOY | $16,397,218 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,738,497 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,137,913 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $16,929,444 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $14,259,305 | NetAssetsOrFundBalancesEOYAmt |
| Mission | STANDING PROUDLY ON THE TRADITIONS AND PERSEVERANCE OF OUR HOSPITAL FOUNDERS, LPH IS DEDICATED TO EXCEL AT PROVIDING HIGH-QUALITY, COMPASSIONATE HEALTHCARE TO ALL WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $10,881,414 | ExpenseAmt |
| Grant | $7,394 | GrantAmt |
| Revenue | $13,392,815 | RevenueAmt |
| Desc | PROVIDE PATIENT HEALTHCARE SERVICES INCLUDING HOSPITAL AND CLINIC SERVICES TO THE SURROUNDING COMMUNITY. THE ORGANIZATION PROVIDED APPROXIMATELY $58,000 OF CHARITY CARE DURING THE YEAR ENDED 06/30/2024. | Desc |
| Total Program Service Expenses | $10,881,414 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 42 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 100 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | 0 | Form8899Filedind |
| DAF Excess Business Holdings | 0 | DAFExcessBusinessHoldingsInd |
| Taxable Distributions | 0 | TaxableDistributionsInd |
| Distribution To Donor | 0 | DistributionToDonorInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | ND | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARI CHAMBERS | PersonNm |
| Phone | 7012566100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 909 2ND ST | AddressLine1Txt |
| City | LANGDON | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58249 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| JAY DUBOIS | |||||||
| PRESIDENT | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SHERRY BUCHWEITZ | |||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KATHRYN KOPF | |||||||
| VICE PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| STEVE HART | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RUNA ANDERSON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CHYRISSE REGEHR | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JACKIE DVORAK | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RICHARD WAYNE REID | |||||||
| CEO BEGINNING NOV 2023 | 40.00 | Yes (X) | $74,574 | $0 | $18,604 | ||
| MICHELLE SKILLINGS | |||||||
| CNO | 40.00 | Yes (X) | $90,381 | $0 | $5,996 | ||
| MARGARET FONTANA | |||||||
| CFO UNTIL NOVEMBER 2023 | 40.00 | Yes (X) | $193,650 | $0 | $11,839 | ||
| DARLA RODER | |||||||
| INTERIM CEO UNTIL 10/23 AND COO | 40.00 | Yes (X) | $219,864 | $0 | $19,548 | ||
| JOSEPH SANDERS | |||||||
| AMBULANCE DIRECTOR | 40.00 | $121,654 | $0 | $9,384 | Yes (X) | ||
| COURTNEY FEIL-SHORT | |||||||
| NURSE PRACTITIONER | 40.00 | $166,324 | $0 | $761 | Yes (X) | ||
| CATHERINE TAYLOR | |||||||
| PHARMACY DIRECTOR | 40.00 | $135,789 | $0 | $15,590 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,002,236 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $81,722 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 11 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | CompensationCompensationAmt |
|---|---|---|---|---|
| NATIONAL MEDICAL RESOURCES INC | ||||
| 2792 E BROADWAY AVE | BISMARCK | ND | 58501 | $776,142 |
| SANFORD HEALTH | ||||
| 1305 W 18TH ST | SIOUX FALLS | SD | 57117 | $669,242 |
| CARDINAL HEALTH 110 LLC | ||||
| 7000 CARDINAL PLACE | DUBLIN | OH | 43017 | $615,263 |
| JOHNSON CONTROLS INC | ||||
| DEPT CH 10320 | PALATINE | IL | 60055 | $538,715 |
| MEDICAL STAFFING PARTNERS INC | ||||
| 880 SW 15TH ST | FOREST LAKE | MN | 55025 | $457,053 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 26 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $347,734 | GovernmentGrantsAmt |
| All Other Contributions | $48,388 | AllOtherContributionsAmt |
| Total Contributions | $396,122 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT REVENUE | 621400 | $12,413,560 | $12,413,560 |
| 340B PHARMACY REVENUE | 621400 | $815,069 | $815,069 |
| LANGDON COUNTY AMBULANCE | 621910 | $164,186 | $164,186 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $13,392,815 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $45,558 | TotalRevenueColumnAmt |
| Exclusion | $45,558 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $31,845 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $31,845 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $31,845 | TotalRevenueColumnAmt |
| Exclusion | $31,845 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $154,914 | TotalRevenueColumnAmt |
| Exclusion | $154,914 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $154,914 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,021,254 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,392,815 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $232,317 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,394 | TotalAmt |
| Program Services | $7,394 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,067,611 | TotalAmt |
| Program Services | $854,089 | ProgramServicesAmt |
| Management And General | $213,522 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,160,032 | TotalAmt |
| Program Services | $3,312,396 | ProgramServicesAmt |
| Management And General | $847,636 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,661 | TotalAmt |
| Program Services | $52,529 | ProgramServicesAmt |
| Management And General | $13,132 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $457,321 | TotalAmt |
| Program Services | $365,857 | ProgramServicesAmt |
| Management And General | $91,464 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $374,410 | TotalAmt |
| Program Services | $299,528 | ProgramServicesAmt |
| Management And General | $74,882 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,780 | TotalAmt |
| Program Services | $12,051 | ProgramServicesAmt |
| Management And General | $13,729 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,217 | TotalAmt |
| Management And General | $74,217 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,192 | TotalAmt |
| Program Services | $16,900 | ProgramServicesAmt |
| Management And General | $9,292 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $90,621 | TotalAmt |
| Management And General | $90,621 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,395 | TotalAmt |
| Program Services | $30,545 | ProgramServicesAmt |
| Management And General | $19,850 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $463,823 | TotalAmt |
| Management And General | $463,823 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $187,136 | TotalAmt |
| Program Services | $130,486 | ProgramServicesAmt |
| Management And General | $56,650 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,065 | TotalAmt |
| Program Services | $36,884 | ProgramServicesAmt |
| Management And General | $6,181 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,941 | TotalAmt |
| Program Services | $22,863 | ProgramServicesAmt |
| Management And General | $6,078 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,037,342 | TotalAmt |
| Program Services | $819,500 | ProgramServicesAmt |
| Management And General | $217,842 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,443 | TotalAmt |
| Program Services | $1,193 | ProgramServicesAmt |
| Management And General | $110,250 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| CONTRACTED SERVICES | $1,775,138 | $1,591,779 | $183,359 |
| FEES | $1,152,933 | $1,152,933 | |
| PURCHASED SERVICES | $983,459 | $585,090 | $398,369 |
| OTHER | $772,332 | $600,868 | $171,464 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,313,142 | TotalAmt |
| Program Services | $988,529 | ProgramServicesAmt |
| Management And General | $324,613 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,268,388 | TotalAmt |
| Program Services | $10,881,414 | ProgramServicesAmt |
| Management And General | $3,386,974 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,222,758 | BOYAmt |
| EOY | $4,507,602 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,073,506 | BOYAmt |
| EOY | $1,649,673 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $262,959 | BOYAmt |
| EOY | $168,072 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $242,040 | BOYAmt |
| EOY | $220,501 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $13,109,612 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,250,724 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,372,006 | BOYAmt |
| EOY | $6,858,888 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,706,700 | BOYAmt |
| EOY | $2,702,618 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,492,861 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,295,111 | BOYAmt |
| EOY | $289,864 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,667,941 | BOYAmt |
| EOY | $16,397,218 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $864,059 | BOYAmt |
| EOY | $911,348 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $447,066 | BOYAmt |
| EOY | $229,462 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $427,372 | BOYAmt |
| EOY | $997,103 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,738,497 | BOYAmt |
| EOY | $2,137,913 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,436,583 | BOYAmt |
| EOY | $14,259,305 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,492,861 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,929,444 | BOYAmt |
| EOY | $14,259,305 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,667,941 | BOYAmt |
| EOY | $16,397,218 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$247,134 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $356,144 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | -$2,492,861 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | -$286,288 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,167 | OtherCostOrOtherBasisAmt |
| Book Value | $13,167 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,301,463 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,631,029 | DepreciationAmt |
| Book Value | $7,670,434 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $106,708 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,458,600 | DepreciationAmt |
| Book Value | -$1,351,892 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,523,173 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,161,095 | DepreciationAmt |
| Book Value | $362,078 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $165,101 | OtherCostOrOtherBasisAmt |
| Book Value | $165,101 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,858,888 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO THIRD PARTY PAYABLES | $834,043 |
| LEASE LIABILITY | $163,060 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $997,103 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $14,091,110 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $356,144 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $356,144 | RevenueNotReportedAmt |
| Revenue Subtotal | $13,734,966 | RevenueSubtotalAmt |
| Other Revenues Not Included | $286,288 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $286,288 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $14,021,254 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $14,268,388 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $14,268,388 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $14,268,388 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART XI, LINE 4B - OTHER ADJUSTMENTS: | FormAndLineReferenceDesc |
| Explanation | LOSS ON WRITE-OFFS OF ASSETS | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | 0 | FPGReferenceFreeCareInd |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $557,065 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $514,979 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $42,086 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $557,065 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $514,979 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $42,086 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,376 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,376 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,376 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,376 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $561,441 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $514,979 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $46,462 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00320 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $314,675 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $6,648,321 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,600,799 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $47,522 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAVALIER COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 909 2ND STREET | AddressLine1Txt |
| City | LANGDON | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58249 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.LPH.HOSPITAL | WebsiteAddressTxt |
| State License | 5029 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAVALIER COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SUPPLEMENTARY INFO. | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://WWW.LPH.HOSPITAL | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | 0 | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.LPH.HOSPITAL | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.LPH.HOSPITAL | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.LPH.HOSPITAL | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CAVALIER COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: THE METHODOLOGY TO CONDUCT THIS ASSESSMENT TAKES A COMPREHENSIVE APPROACH TO ASSESS COMMUNITY HEALTH NEEDS, PERFORM SEVERAL INDEPENDENT DATA ANALYSES BASED ON SECONDARY SOURCE DATA, AUGMENT THIS WITH LOCAL EXPERT ADVISOR OPINIONS, AND RESOLVE ANY DATA INCONSISTENCY OR DISCREPANCIES BY REVIEWING THE COMBINED OPINIONS FORMED FROM LOCAL EXPERT ADVISORS. THE HOSPITAL RELIES ON SECONDARY SOURCE DATA, AND MOST SECONDARY SOURCES USE THE COUNTY AS THE SMALLEST UNIT OF ANALYSIS. LOCAL EXPERT AREA RESIDENTS WERE ASKED TO NOTE IF THEY PERCEIVED THE PROBLEMS OR NEEDS IDENTIFIED BY SECONDARY SOURCES EXISTED IN THEIR PORTION OF THE COUNTY. NPUT WAS OBTAINED FROM THE REQUIRED THREE MINIMUM SOURCES AND EXPANDED TO INCLUDE OTHER REPRESENTATIVE GROUPS. THE HOSPITAL ASKED ALL THOSE PARTICIPATING IN THE WRITTEN COMMENT SOLICITATION PROCESS TO SELF-IDENTIFY INTO ANY OF THE FOLLOWING REPRESENTATIVE CLASSIFICATIONS, WHICH ARE DETAILED IN AN APPENDIX TO THIS REPORT. |
| CAVALIER COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6B: CAVALIER COUNTY MEMORIAL HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT WITH QHR HEALTH.PART V, LINE 7A:HTTPS://WWW.LPH.HOSPITAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPART V, LINE 10:HTTPS://WWW.LPH.HOSPITAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT |
| CAVALIER COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: THE 2022 SIGNIFICANT HEALTH NEEDS IDENTIFIED FOR CAVALIER COUNTY ARE:1. BEHAVIORAL HEALTH:A. HOSPITAL SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE:BEHAVIORAL MENTAL HEALTH TASK FORCE A LOCAL GROUP THAT CONSISTS OF REPRESENTATIVES FROM PUBLIC HEALTH, LAW ENFORCEMENT, SOCIAL SERVICES, THE BOARD OF EDUCATION, AND LPH; DEPRESSION SCREENINGS ARE PERFORMED DURING EVERY VISIT AT THE PRIMARY CARE CLINIC; TELE-PSYCHIATRY OFFERINGS.B. IMPACT OF ACTIONS TAKEN SINCE THE IMMEDIATE PRECEDING CHNA: ALCOHOLICS ANONYMOUS (AA) SERVICES ARE NOW PROVIDED AT WALHALLA CLINIC; LPH HAS A PROVIDER TRAINED IN CHILD BEHAVIORAL HEALTH; WALHALLA CLINIC OFFERS A ROBUST MEDICAL MARIJUANA PROGRAM TO LIMIT OPIOID USE AMONG CHRONIC PAIN PATIENTS.C. ADDITIONALLY, THE HOSPITAL PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED:ADD ALCOHOLICS ANONYMOUS/NARCOTICS ANONYMOUS (AA/NA) SERVICES;INCREASE EDUCATION AND AWARENESS ON MENTAL HEALTH IN THE COMMUNITY; WORK WITH ADDICTION COUNSELORS IN THE AREA TO CONNECT AA/NA PARTICIPANTS WITH THEIR SERVICES; EXPLORE POTENTIAL SCREENING PROTOCOLS FOR DRUG/SUBSTANCE/ALCOHOL USE; INCREASE EDUCATION FOR PHYSICIANS TO BE AWARE OF COUNSELORS THAT THEY CAN REFER PATIENTS TO; CONTINUE WORK WITH THE BEHAVIORAL MENTAL HEALTH TASK FORCE; EXPLORE THE DEVELOPMENT OF A SUBOXONE TREATMENT PROGRAM THROUGH A CERTIFIED PROVIDER; DEVELOP AND SUPPORT PROVIDERS WHO ARE INTERESTED IN BEHAVIORAL HEALTH. 2. CHRONIC DISEASE MANAGEMENT:A. HOSPITAL SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: CARAVAN HEALTH COLLABORATIVE LPH ACCOUNTABLE CARE ORGANIZATION (ACO); COMPREHENSIVE PRIMARY CARE SERVICES; CHRONIC CARE MANAGEMENT SERVICES CHRONIC DISEASE PATIENTS RECEIVE PHONE CALLS EVERY OTHER WEEK FROM HEALTHCARE PROFESSIONALS TO REVIEW HOW THEIR CARE IS GOING; TRANSITIONAL CARE MANAGEMENT SERVICES PATIENTS DISCHARGED FROM THE HOSPITAL WITH A CHRONIC CONDITION RECEIVE A CALL TO ENSURE A FOLLOW-UP APPOINTMENT IS SCHEDULED AT THE CLINIC; LPH PROVIDERS CONDUCT ANNUAL WELLNESS VISITS; POPULATION HEALTH NURSE AVAILABLE ON STAFF; LPH CONDUCTS AN ANNUAL HEALTH FAIR WITH OVER 30 DIFFERENT VENDORS; LPH CONDUCTS WOMEN'S HEALTH DAY AND MEN'S HEALTH DAY TO PROVIDE SCREENING SERVICES; COVID-19 PREVENTION AND EDUCATION SERVICES; TELEMEDICINE APPOINTMENTS ARE AVAILABLE ACROSS A RANGE OF SERVICE LINES; CAVALIER COUNTY SENIOR MEALS AND SERVICES AND THE FOUNDATION PROVIDE FREE MEALS FOR TWO WEEKS AFTER DISCHARGE TO MEDICARE PATIENTS; SCREENING SERVICES: BLOOD PRESSURE MONITORING; BONE DENSITY TESTING; COLONOSCOPIES; DIABETES MANAGEMENT; DOT YEARLY PHYSICALS; LAB TESTING; MAMMOGRAPHY; SPORTS PHYSICALS; WELLNESS CHECK-UPS; VISITING OUTREACH PROVIDERS; CARDIOLOGY; DERMATOLOGY; OB/GYN; ONCOLOGY; ORTHOPEDICS; PAIN MANAGEMENT; GI.B. ADDITIONALLY, THE HOSPITAL PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: WORK WITH COMMERCIAL INSURANCES TO BROADEN CHRONIC CARE MANAGEMENT SERVICES TO ALL PATIENTS; INCREASE EDUCATION AND AWARENESS AROUND CHRONIC DISEASES ON SOCIAL MEDIA; INITIATE COMMUNITY PARAMEDIC PROGRAM, INCLUDING DISEASE MONITORING AND MEDICATION MANAGEMENT FOR CHF AND COPD; EXPLORE POTENTIAL PROGRAMS TO PROVIDE CARE IN A PATIENT'S HOME AS AN ALTERNATIVE TO LONG-TERM CARE; EVALUATE THE POTENTIAL OF INCREASING SPECIALTY ROTATIONS FOR SERVICES THAT ARE HEAVILY UTILIZED.3. ACCESS TO HEALTHCARE SERVICES: A. HOSPITAL SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: WEEKEND CLINIC HOURS; 24-HOUR EMERGENCY CARE AND SWING BED SERVICES; TELEMEDICINE APPOINTMENTS ARE AVAILABLE ACROSS A RANGE OF SERVICE LINES; VISITING OUTREACH PROVIDERS; CARDIOLOGY; DERMATOLOGY; OB/GYN; ONCOLOGY; ORTHOPEDICS; PAIN MANAGEMENT; GI; FINANCIAL ASSISTANCE POLICY FOR PATIENTS UP TO 200% OF THE FEDERAL POVERTY LINE; PRICE TRANSPARENCY PRICE ESTIMATOR TOOL AVAILABLE ON THE HOSPITAL'S WEBSITE; SCREENING FOR FINANCIAL ASSISTANCE POLICY IS INCLUDED ON ALL STATEMENTS AND APPLICATIONS ARE INCLUDED WITH PATIENT PACKETS; BILLING SUPPORT STAFF AVAILABLE ONSITE AT LPH; SOCIAL WORKER ON STAFF TO HELP CONNECT PATIENTS TO AVAILABLE RESOURCES; HOSPITAL-BACKED LOANS FOR PATIENTS THROUGH CHOICE FINANCIAL BANK; FREE HEALTH SCREENINGS FOR EMPLOYEES DURING HEALTHCARE WORKER APPRECIATION WEEK; OUTREACH CLINIC IN WALHALLA; LPH CONDUCTS AN ANNUAL HEALTH FAIR WHERE FREE HEALTH SCREENINGS ARE PROVIDED; AGREEMENT WITH THE UNIVERSITY OF NORTH DAKOTA TO TRAIN AND RECRUIT MEDICAL, NURSING, AND PHYSICIAN ASSISTANT STUDENTS; ON THE HORIZON: LPH'S COMMUNITY MAGAZINE PROVIDES STORIES FROM PATIENTS AND FEATURES INFORMATION ABOUT HOSPITAL SERVICES AND HEALTH TIPS.B. IMPACT OF ACTIONS TAKEN SINCE THE IMMEDIATELY PRECEDING CHNA: UPDATED FINANCIAL ASSISTANCE POLICY; OPTIMIZED HOSPITAL WEBSITE TO BE MORE USER-FRIENDLY AND TO PROVIDE CLEAR INFORMATION ON SERVICES AVAILABLE; IMPROVED HOSPITAL SIGNAGE TO SUPPORT COMMUNITY AWARENESS AND WAYFINDING.C. ADDITIONALLY, THE HOSPITAL PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: ADD EARLY AND LATE WEEKDAY HOURS AT THE CLINIC; CONTINUE TO EXPAND TELEMEDICINE OFFERINGS; CONTINUE TO IMPROVE BILLING PROCESSES AT THE HOSPITAL; CONTINUE TO INVEST IN THE LOCAL COMMUNITY FOR NURSING STAFF. |
| CAVALIER COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 13B: PATIENTS WHO HAVE DIED AND HAVE NO ESTATE ARE DEEMED BY CCMH TO HAVE NO INCOME FOR THE PURPOSE OF DETERMINING CHARITY CARE ELIGIBILITY. |
| CAVALIER COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 16J: THE ORGANIZATION DID NOT TRANSLATE THE FAP INTO ANY OTHER LANGUAGE THAN THE ENGLISH. THERE IS LESS THAN 4% NON-ENGLISH SPEAKING POPULATION IN THE AREA THE HOSPITAL SERVES AND THERE IS NOT A REQUIREMENT TO TRANSLATE THE FAP.PART V, LINE 16A, FAP WEBSITE:HTTPS://WWW.LPH.HOSPITAL/INSURANCE-ASSISTANCEPART V, LINE 16B, FAP APPLICATION WEBSITE:HTTPS://WWW.LPH.HOSPITAL/INSURANCE-ASSISTANCEPART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:HTTPS://WWW.LPH.HOSPITAL/INSURANCE-ASSISTANCE |
| CAVALIER COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 20E: ALL PATIENTS RECEIVE LETTERS AFTER NONPAYMENT THAT INCLUDE A PLAIN LANGUAGE SUMMARY OF OUR FINANCIAL ASSISTANCE PLAN. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - LANGDON CLINIC | ||||
| 909 2ND STREET | LANGDON | ND | 58249 | OUTPATIENT PHYSICIAN CLINIC - RURAL HEALTH CLINIC |
| 2 - WALHALLA CLINIC | ||||
| 301 5TH STREET | WALHALLA | ND | 58282 | OUTPATIENT PHYSICIAN CLINIC - RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART III, LINE 2: | THE ORGANIZATION'S BAD DEBT EXPENSE IS THE BAD DEBT EXPENSE LESS BAD DEBT RECOVERIES AS REPORTED ON THE FINANCIAL STATEMENTS MULTIPLIED BY THE COST TO CHARGE RATIO. |
| PART III, LINE 3: | THE ORGANIZATION HAS A VERY ROBUST FINANCIAL ASSISTANCE PROGRAM; THEREFORE, NO ESTIMATE IS MADE FOR BAD DEBT ATTRIBUTED TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. |
| PART III, LINE 4: | GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE HOSPITAL ALSO PROVIDES SERVICES TO UNINSURED PATIENTS AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FOR THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. CREDIT LOSS EXPENSE FOR THE YEARS ENDED JUNE 30, 2024 WAS NOT SIGNIFICANT.CONSISTENT WITH THE HOSPITAL'S MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, THE HOSPITAL HAS DETERMINED IT HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH OTHER UNINSURED BALANCES (I.E., COPAYS AND DEDUCTIBLES). THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN THE AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS THE HOSPITAL EXPECTS TO COLLECT BASED ON ITS COLLECTION HISTORY WITH THOSE PATIENTS. THE HOSPITAL'S POLICY IS TO PROVIDE DISCOUNTS RANGING FROM 20 TO 100 PERCENT UNDER A SLIDING FEE SCHEDULE THAT IS BASED ON FAMILY SIZE AND INCOME IN RELATION TO FEDERAL POVERTY GUIDELINES. THIS POLICY DID NOT CHANGE IN 2024. |
| PART III, LINE 9B: | IF A PATIENT QUALIFIES FOR CHARITY CARE, A PERCENTAGE OF THEIR BILL IS WRITTEN OFF DEPENDING ON THEIR INCOME LEVEL. THE BALANCE THAT REMAINS IS SUBJECT TO OUR COLLECTION POLICY. IF A PAYMENT HAS NOT BEEN MADE FOR 2 MONTHS, A 1ST LETTER IS SENT STATING THAT THEY HAVE A MONTH TO MAKE A PAYMENT. IF A PAYMENT HAS NOT BEEN MADE AFTER THAT MONTH, A 2ND LETTER IS SENT OUT STATING THEY HAVE ANOTHER MONTH TO MAKE A PAYMENT. IF A PAYMENT HAS STILL NOT BEEN MADE, THEN THEY ARE TURNED OVER TO OUR COLLECTION AGENCY. |
| PART III, LINE 3 | THE ORGANIZATION HAS A VERY ROBUST FINANCIAL ASSISTANCE PROGRAM; THEREFORE, NO ESTIMATE IS MADE FOR BAD DEBT ATTRIBUTED TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. |
| PART VI, LINE 2 | LANGDON PRAIRIE HEALTH ACTIVELY ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY BY EVALUATING THE PROGRESS AND SUCCESS OF PREVIOUS COMMUNITY NEEDS ASSESSMENTS, EVALUATING QUALITY METRICS, PATIENT SATISFACTION SURVEYS, AND ACO RESULTS. ALL DEPARTMENTS PARTICIPATE IN LPH'S QUALITY ASSURANCE PROGRAM WHICH MEASURES PATIENT SATISFACTION AND THE QUALITY OF THE SERVICES PROVIDED AND PROVIDES AN OPPORTUNITY FOR IMPROVING PROCESSES RESULTING IN IMPROVED HEALTHCARE FOR OUR COMMUNITY. |
| PART VI, LINE 3 | LANGDON PRAIRIE HEALTH OFFERS ASSISTANCE TO ALL PATIENTS THAT ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. OUR WEBSITE, FACEBOOK PAGE, BILLING STATEMENTS COMMUNITY CALENDAR AND PATIENT HANDBOOK INDICATE WHO TO CONTACT IN ORDER TO APPLY. BUSINESS OFFICE STAFF ALSO MONITOR PATIENT ACCOUNTS THAT ARE DORMANT AND IN JEOPARDY OF COLLECTIONS, CONTACT THOSE PATIENTS AND OFFER ASSISTANCE IN THE APPLICATIONS PROCESS AS WELL. |
| PART VI, LINE 4 | CAVALIER COUNTY IS LOCATED IN THE STATE OF NORTH DAKOTA AND ACCORDING TO THE US CENSUS 2022 HAS A POPULATION OF APPROXIMATELY 3,362. PERSONS 65 YEARS AND OLDER MAKE UP 27.2% AND PERSONS UNDER 18% MAKE UP 29%. THE WHITE RACE MAKES UP APPROXIMATELY 96% WHILE THE HISPANIC OR LATINO MAKES UP 2.5. OF THE 1,153 HOUSEHOLDS THERE WERE 2.34 PERSONS LIVING IN EACH HOUSEHOLD. THE MEDIAN HOUSEHOLD INCOME WAS $60,284 AND 8% WERE CONSIDERED TO BE IN POVERTY. THE POPULATION PER SQUARE MILE IS 2.5 IN AN AREA OF 1,489. 6.3% PERSONS SUFFER FROM A DISABILITY AND 7.1% ARE UNINSURED. THE COUNTY WAS FOUNDED IN 1879 AND THE COUNTY SEAT IS LOCATED IN LANGDON. |
| PART VI, LINE 5 | LPH AND CLINICS FURTHER THEIR EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY BY OFFERING SEVERAL PROGRAMS FOR FINANCIAL ASSISTANCE, OFFERING HEALTH FAIRS AND FREE AND REDUCED HEALTH ASSESSMENTS AND TESTING. CHARITY CARE IS OFFERED AND EMERGENCY SERVICES ARE PROVIDED REGARDLESS OF A PATIENT'S ABILITY TO PAY. ANY CONTRIBUTIONS MADE TO THE ORGANIZATION ARE TAX DEDUCTIBLE AND APPLIES FOR GRANTS TO PURCHASE NEEDED EQUIPMENT AND PROVIDE ADVANCED MEDICAL TRAINING. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | ND |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | STUDENT LOAN REPAYMENT PROGRAM | GrantTypeTxt |
| Recipient | 1 | RecipientCnt |
| Cash Grant | $7,394 | CashGrantAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DARLA RODER | ||||||||||||||
| INTERIM CEO UNTIL 10/23 AND COO | $219,864 | $0 | $0 | $0 | $0 | $0 | $6,882 | $0 | $12,666 | $0 | $239,412 | $0 | $0 | $0 |
| MARGARET FONTANA | ||||||||||||||
| CFO UNTIL NOVEMBER 2023 | $193,650 | $0 | $0 | $0 | $0 | $0 | $5,879 | $0 | $5,960 | $0 | $205,489 | $0 | $0 | $0 |
| COURTNEY FEIL-SHORT | ||||||||||||||
| NURSE PRACTITIONER | $166,324 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $761 | $0 | $167,085 | $0 | $0 | $0 |
| CATHERINE TAYLOR | ||||||||||||||
| PHARMACY DIRECTOR | $135,789 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $15,590 | $0 | $151,379 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF LANGDON NORTH DAKOTA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 456002108 | BondIssuerEIN |
| CUSIP | 515679AL2 | CUSIPNum |
| Bond Issued | 2010-03-25 | BondIssuedDt |
| Issue Price | $2,500,000 | IssuePriceAmt |
| Purpose | HOSPITAL RENOVATION PROJECT | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $2,265,000 | RetiredAmt |
| Total Proceeds | $2,500,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $50,000 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $2,450,000 | CapitalExpendituresAmt |
| Refunding Tax Exempt Bonds | 0 | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS ONE CLASS OF MEMBERS. A MEMBER OF THE CORPORATION IS SOMEONE 18 YEARS OF AGE OR OLDER AND RESIDING IN THE CORPORATION'S SERVICE AREA (50 MILE RADIUS). A MEMBER MUST APPLY AND THE BOARD OF TRUSTEES HAS THE POWER TO REVIEW ELIGIBILITY AS APPROPRIATE. ONCE A MEMBER, THE PERSON HAS THE RIGHT TO ATTEND THE ANNUAL MEETING (NOVEMBER), RECEIVE A COPY OF THE ANNUAL REPORT AND VOTE ON MATTERS BROUGHT TO THE MEMBERS BY THE BOARD OF TRUSTEES. MEMBERS DO NOT VOTE ON THE BOARD OF TRUSTEES POSITIONS. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 IS FIRST REVIEWED BY THE CHIEF FINANCIAL OFFICER. THE FINANCE COMMITTEE WILL LOOK AT THE RETURN FOLLOWING THE CFO. FINALLY, THE BOARD OF DIRECTORS WILL RECEIVE AN ELECTRONIC COPY OF THE FORM 990 PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | DIRECTORS, OFFICERS, AND TRUSTEES OF THE ORGANIZATION ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY. POTENTIAL OR POSSIBLE CONFLICTS OF INTEREST ARE REVIEWED AT THE BOARD LEVEL AND A DETERMINATION IS MADE. RESTRICTIONS AND/OR ADJUSTMENTS ARE DETERMINED AND THEN IMPLEMENTED PER BOARD DIRECTION. RESTRICTIONS AND/OR ADJUSTMENTS ARE DOCUMENTED WITHIN THE BOARD MINUTES. IF ANY VARIANCES OF THE CONFLICT IN QUESTION ARE DISCOVERED THE BOARD WILL MAKE A DETERMINATION ON THE ACTION TO BE TAKEN. ANY POTENTIAL CONFLICT OF INTEREST ON THE PART OF ANY MEMBER OF THE BOARD OF DIRECTORS SHALL BE DISCLOSED IN WRITING TO THE BOARD AND MADE A MATTER OF RECORD THROUGH AN ANNUAL DISCLOSURE AND ALSO WHEN THE INTEREST INVOLVED A SPECIFIC ISSUE OR TRANSACTION BEFORE THE BOARD. IF A CONFLICT ARISES AFTER A MEMBER HAS COMPLETED THE DISCLOSURE, THE MEMBER SHOULD COMPLETE AN AMENDED DISCLOSURE INCLUDING THE NEW CONFLICT. IF AN INDIVIDUAL HAS A CONFLICT OF INTEREST, THE ENTIRE BOARD OF DIRECTORS VOTES ON APPROVAL OR DISAPPROVAL OF THE TRANSACTION. THE MEMBER INVOLVED IN THE TRANSACTION REFRAINS FROM VOTING OR OTHERWISE ATTEMPTING TO EXERT ANY INFLUENCE ON THE OTHER MEMBERS THAT WILL AFFECT THEIR DECISION ON THE ISSUE. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE PROCEDURE THAT CCMH UTILIZES TO DETERMINE ITS CEO'S COMPENSATION IS AS FOLLOWS. UPON EXPIRATION OF CEO'S CONTRACT, THE CCMH BOARD OF DIRECTORS (BOD) CALLS FOR AN EXECUTIVE SESSION TO DISCUSS THE CEO'S CONTINUED/DISCONTINUED EMPLOYMENT. UPON APPROVAL TO CONTINUE THE CEO'S EMPLOYMENT, THE BOD PRESENTS AND REVIEWS THE CURRENT NORTH DAKOTA PREVAILING WAGE DATA COMMENSURATE WITH CEO JOB DESCRIPTION. ONCE AN APPROPRIATE COMPENSATION FIGURE HAS BEEN NEGOTIATED AND ACCEPTED BY THE CEO, THE BOD PASSES A MOTION TO RATIFY THE COMPENSATION AGREEMENT BETWEEN THE BOD AND CEO. FINALLY, REQUIRED DELIVERABLES AND OTHER MEASURABLE INDICATORS ARE MEMORIALIZED IN A FORMAL AGREEMENT OR CONTRACT WITH THE CEO. THE PROCEDURES UTILIZED BY CCMH TO SET WAGES FOR SUBORDINATE OFFICERS AND ALL OTHER EMPLOYEES IS DETERMINED BY THE CEO WHO IS EMPOWERED BY THE BOD TO DO SO. THE CEO REVIEWED THE CURRENT NORTH DAKOTA JOB SERVICE EDITION AND NORTH DAKOTA HEALTHCARE ASSOCIATION WAGES/SALARY ADJUSTMENTS OF SUBORDINATE OFFICERS AND EMPLOYEES IS SUPPLIED TO THE BOARD UPON REQUEST. FINALLY, THE APPROPRIATE COMPENSATION AND OTHER DELIVERABLES ARE MEMORIALIZED IN A FORMAL OFFER LETTER EXTENDED TO THE EMPLOYEE. |
| FORM 990, PART VI, SECTION C, LINE 19 | CAVALIER COUNTY MEMORIAL HOSPITAL MAKES THEIR GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE FINANCIAL STATEMENTS ARE ALSO PRESENTED ANNUALLY AT THE PUBLIC MEMBERS' MEETING. |
| FORM 990, PART XI, LINE 9: | LOSS ON WRITE-OFF OF ASSETS -286,288. |
| FORM 990, PART XII, LINE 2C | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |