ST LUKES HOSPITAL: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- ST LUKES HOSPITAL (EIN 45-0254692)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-01
- IRS object ID
- 202301219349301900
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-01T11:34:21-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1730 Burnt Boat Loop Ste 100 | AddressLine1Txt |
| City | Bismarck | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 585030886 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450254692 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Lukes Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STLU | BusinessNameControlTxt |
| Phone | 7019656384 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 702 1st Street SW PO Box 10 | AddressLine1Txt |
| City | Crosby | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58730 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jody Nelson | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7019656384 | PhoneNum |
| Signature | 2023-05-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Jody | PersonFirstNm |
| Person Last | Nelson | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Lisa Chaffee CPA | PreparerPersonNm |
| PTIN | P00193453 | PTIN |
| Phone | 7012551091 | PhoneNum |
| Preparation | 2023-05-01 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Jody Nelson | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 702 1st Street SW PO Box 10 | AddressLine1Txt |
| City | Crosby | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58730 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $8,789,558 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.dcstlukes.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1984 | FormationYr |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Activity Or Mission | To provide health care services to Crosby and the surrounding area. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 103 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $5,698,182 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,568,312 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $8,637,259 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $8,524,611 | CYProgramServiceRevenueAmt |
| PY Investment Income | $10,123 | PYInvestmentIncomeAmt |
| CY Investment Income | -$36,292 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | -$1,310,541 | CYOtherRevenueAmt |
| PY Total Revenue | $14,345,564 | PYTotalRevenueAmt |
| CY Total Revenue | $8,746,090 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,648,228 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,353,752 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,867,220 | PYOtherExpensesAmt |
| CY Other Expenses | $4,479,594 | CYOtherExpensesAmt |
| PY Total Expenses | $11,515,448 | PYTotalExpensesAmt |
| CY Total Expenses | $9,833,346 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,830,116 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,087,256 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $11,612,014 | TotalAssetsBOYAmt |
| Total Assets EOY | $9,653,668 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,862,610 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,965,570 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,749,404 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,688,098 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | The mission of St. Luke's Hospital is to provide comprehensive and compassionate health care for individuals and families in cooperation with the area medical community. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Expense | $8,366,132 | ExpenseAmt |
| Revenue | $7,214,070 | RevenueAmt |
| Desc | St. Luke's Hospital is a 20-bed hospital that promotes health of the community by providing a variety of health care services. We provide pediatric care, acute care, skilled swing bed, nonskilled swing bed, respite care for the elderly, congregate meals, emergency room, operating room, ambulatory, physical therapy, contracted speech, and occupational therapy services.We provide some charity care in the form of direct write-offs and indirect write-offs of contractual bad debts and slow pays where we charge no interest even if the pay back is as much as 30 years. Based on charges foregone, the hospital provided $28,270 in charity care during the fiscal year. | Desc |
| Total Program Service Expenses | $8,366,132 | 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 | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | 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 | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| 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 | Yes (1) | 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 | 18 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 103 | 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 |
| 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | 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 | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jody Nelson | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7019656384 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 10 | AddressLine1Txt |
| City | Crosby | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58730 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 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 |
|---|---|---|---|---|---|---|---|
| Jerry King | |||||||
| President | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Philip Johnson | |||||||
| Vice President (Jul-Nov) | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Becky Knudson | |||||||
| Dir (Jul-Nov)/VP (Dec-Jun) | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Jody Nelson | |||||||
| CEO | 40.00 | Yes (X) | $178,517 | $0 | $5,355 | ||
| Megan Peterson | |||||||
| CFO starting Nov 2021 | 40.00 | Yes (X) | $77,098 | $0 | $3,309 | ||
| Loren Johnson | |||||||
| Secretary/Treasurer | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Mark Holm | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Benjamin Krogh | |||||||
| Physician | 40.00 | $256,457 | $0 | $30,357 | Yes (X) | ||
| Christine Knudsvig | |||||||
| Family Nurse Practitioner | 40.00 | $233,743 | $0 | $14,620 | Yes (X) | ||
| Stanley Stevens | |||||||
| Family Nurse Practitioner | 40.00 | $227,821 | $0 | $17,129 | Yes (X) | ||
| James Hodges | |||||||
| Physician Assistan | 40.00 | $217,677 | $0 | $26,566 | Yes (X) | ||
| Belinda Moen | |||||||
| Care Center Administrator | 40.00 | $105,418 | $0 | $17,838 | Yes (X) | ||
| Sandra Simonson | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Wanda Ely | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Ryan Wissbrod | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Art Schilke | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Kjell Vassen | |||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,296,731 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $115,174 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | 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 | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Primetime Healthcare LLC | |||||
| PO Box 3544 | Omaha | NE | 68103 | Travel Staffing Agency | $376,057 |
| Fusion Medical Staffing | |||||
| PO Box 82674 | Lincoln | NE | 68501 | Travel Staffing Agency | $331,216 |
| LRS Healthcare | |||||
| 11320 N 103 Plaze | Omaha | NE | 68114 | Travel Staffing Agency | $162,207 |
| Avant Healthcare Professionals | |||||
| PO Box 744554 | Atlanta | GA | 30374 | Travel Staffing Agency | $125,208 |
| Comtrix Solutions | |||||
| 23099 Red Sunset Place | Aldie | VA | 20105 | Travel Staffing Agency | $108,857 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $771,047 | GovernmentGrantsAmt |
| All Other Contributions | $797,265 | AllOtherContributionsAmt |
| Total Contributions | $1,568,312 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenu | 621110 | $8,198,463 | $8,198,463 |
| 340B Program | 446110 | $186,611 | $186,611 |
| Supporting Revenue | 900099 | $106,290 | $106,290 |
| Cafeteria | 900099 | $33,247 | $33,247 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $8,524,611 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,176 | TotalRevenueColumnAmt |
| Exclusion | $7,176 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $43,468 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$43,468 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$43,468 | TotalRevenueColumnAmt |
| Exclusion | -$43,468 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Discontinued NH Oper. | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | -$1,310,541 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$1,310,541 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | -$1,310,541 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,746,090 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $7,214,070 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$36,292 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $274,352 | TotalAmt |
| Management And General | $274,352 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,407 | TotalAmt |
| Program Services | $103,407 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,983,063 | TotalAmt |
| Program Services | $3,766,146 | ProgramServicesAmt |
| Management And General | $216,917 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $117,609 | TotalAmt |
| Program Services | $112,807 | ProgramServicesAmt |
| Management And General | $4,802 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $538,806 | TotalAmt |
| Program Services | $479,263 | ProgramServicesAmt |
| Management And General | $59,543 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $336,515 | TotalAmt |
| Program Services | $299,327 | ProgramServicesAmt |
| Management And General | $37,188 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,777,589 | TotalAmt |
| Program Services | $1,598,534 | ProgramServicesAmt |
| Management And General | $179,055 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,282 | TotalAmt |
| Management And General | $9,282 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,904 | TotalAmt |
| Program Services | $111,981 | ProgramServicesAmt |
| Management And General | $15,923 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $486,739 | TotalAmt |
| Program Services | $412,013 | ProgramServicesAmt |
| Management And General | $74,726 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,590 | TotalAmt |
| Program Services | $15,590 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,814 | TotalAmt |
| Program Services | $28,750 | ProgramServicesAmt |
| Management And General | $4,064 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $239,544 | TotalAmt |
| Program Services | $200,160 | ProgramServicesAmt |
| Management And General | $39,384 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $496,901 | TotalAmt |
| Program Services | $416,827 | ProgramServicesAmt |
| Management And General | $80,074 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,672 | TotalAmt |
| Program Services | $4,800 | ProgramServicesAmt |
| Management And General | $10,872 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $513,042 | $513,042 | |
| Repairs and Maintenance | $424,783 | $146,356 | $278,427 |
| Sales Tax | $2,159 | $2,159 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $337,575 | TotalAmt |
| Program Services | $157,129 | ProgramServicesAmt |
| Management And General | $180,446 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,833,346 | TotalAmt |
| Program Services | $8,366,132 | ProgramServicesAmt |
| Management And General | $1,467,214 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,930,174 | BOYAmt |
| EOY | $1,156,212 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $153,270 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,026,855 | BOYAmt |
| EOY | $698,855 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $212,817 | BOYAmt |
| EOY | $369,085 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,262 | BOYAmt |
| EOY | $23,621 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $13,124,265 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $8,607,160 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,471,973 | BOYAmt |
| EOY | $4,517,105 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $679,772 | BOYAmt |
| EOY | $1,269,847 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $632,090 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $235,161 | BOYAmt |
| EOY | $833,583 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,612,014 | BOYAmt |
| EOY | $9,653,668 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $874,856 | BOYAmt |
| EOY | $996,641 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,329 | BOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,802 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,362,335 | BOYAmt |
| EOY | $5,678,696 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,590,288 | BOYAmt |
| EOY | $290,233 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,862,610 | BOYAmt |
| EOY | $6,965,570 | 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 | $3,732,519 | BOYAmt |
| EOY | $1,965,101 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,885 | BOYAmt |
| EOY | $722,997 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,749,404 | BOYAmt |
| EOY | $2,688,098 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,612,014 | BOYAmt |
| EOY | $9,653,668 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,087,256 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $25,950 | OtherChangesInNetAssetsAmt |
| 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $83,247 | OtherCostOrOtherBasisAmt |
| Book Value | $83,247 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,452,905 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,902,084 | DepreciationAmt |
| Book Value | $3,550,821 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,760,502 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,394,994 | DepreciationAmt |
| Book Value | $365,508 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $827,611 | OtherCostOrOtherBasisAmt |
| Depreciation | $310,082 | DepreciationAmt |
| Book Value | $517,529 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,517,105 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Beneficial interest in charitable remainder trust | Desc |
| Book Value | $632,090 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $632,090 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Receivable from St. Lukes Community Foundation | $89,183 |
| Estimated Third Party Payor Settlements | $744,400 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $833,583 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CMS Advance Payments | Desc |
| Amt | $290,233 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $290,233 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $8,815,508 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $25,950 | OtherRevenueAmt |
| Revenue Not Reported | $25,950 | RevenueNotReportedAmt |
| Revenue Subtotal | $8,789,558 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$43,468 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$43,468 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $8,746,090 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $9,876,814 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $43,468 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $43,468 | ExpensesNotReportedAmt |
| Expenses Subtotal | $9,833,346 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $9,833,346 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax liabilities in income tax expense if such interest and penalties are incurred. |
| Part XI, Line 2d - Other Adjustments: | Change in beneficial interest in charitable remainder unitrust 25,950. |
| Part XI, Line 4b - Other Adjustments: | Loss on disposal of assets included in expenses in financial statements -43,468. |
| Part XII, Line 2d - Other Adjustments: | Loss on disposal of assets included in revenues on tax Form 990 43,468. |
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 | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 110.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $42,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $42,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00430 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,562,709 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,471,640 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $91,069 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00930 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,604,709 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,471,640 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $133,069 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01360 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,448,407 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,917,585 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $530,822 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05400 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,448,407 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,917,585 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $530,822 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05400 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,053,116 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,389,225 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $663,891 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06760 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $11,744 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,116 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,828,607 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,808,278 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $20,329 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| 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 | St Luke's Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 702 1st St SW | AddressLine1Txt |
| City | Crosby | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58730 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.dcstlukes.org | WebsiteAddressTxt |
| State License | 5011 | 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 | St Luke's 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 | 21 | 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 | www.dcstlukes.org/resources | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.dcstlukes.org/resources | 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 | 110.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Explained Basis | Yes (1) | 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 |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.dcstlukes.org/resources | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.dcstlukes.org/resources | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.dcstlukes.org/resources | 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 |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| St. Luke's Hospital | Part V, Section B, Line 5: The Hospital provided a survey to area residents via paper and electronic methods to complete. The Hospital also provided a list of community leaders representing all sectors of their community, including business, faith, education, health care and agriculture to the Center for Rural Health. The Center for Rural Health contacted community leaders for input via phone interviews, mail or online. A survey was also provided to all staff employed by St. Luke's Hospital. Residents at St. Luke's Living Center and Northern Lights Villa were also given paper copies of the survey to complete. |
| St. Luke's Hospital | Part V, Section B, Line 6b: Divide County Social Services, Divide County School District, Center for Rural Health, Upper Missouri Division Health Unit, local churches, local business owners and public officials. |
| St. Luke's Hospital | Part V, Section B, Line 7d: A hard copy is placed in the lobby. |
| St. Luke's Hospital | Part V, Section B, Line 11: Priority concerns found in the 2021 (FY22) Community Health Needs Assessment include the following: Depression and anxiety in all stages of life, youth bullying/cyberbullying, alcohol use and abuse, availability of mental health and substance use disorder treatment services, and availability of resources to help elderly stay in their homes. These needs were largely similar to the needs identified in the prior CHNA conducted.The facility has intentions of addressing all the needs identified. In FY22 the facilty continued to offer telehealth mental health services in the clinic and are trying to increase our number of available appointments as well as providers able to offer behavioral and mental health services. We are looking at being able to offer in person behavioral and mental health services in the clinic as well. St. Luke's will be implementing a new program known as Senior Life Solutions in a partnership with Psychiatric Medical Care. The development of the Senior Life Solutions program will be conducted over a period of 120 days. This program will provide specialized geriatric care for patients. Some of this specialized care may include treatment for symptoms related to depression, anxiety, grief, memory loss associated with depression, etc. The goal is to provide psychiatrist directed treatment for the older population that isn't typically available within their community setting. |
| St. Luke's Hospital | Part V, Section B, Line 13b: The Hospital uses both an income-asset test and the federal poverty guidelines (FPG) located at http://aspe.hhs.gov/poverty to determine eligibility for financial assistance on medically emergent care claims. |
| St. Luke's Hospital | Part V, Section B, Line 15e: We provide contact information for Divide County Social Services, local accounting firms, and Divide County Economic Development for those who may need additional no-cost options for assistance in filling these forms out. |
| St. Luke's Hospital | Part V, Section B, Line 16j: In addition to having the full policy available upon request and providing the full policy to each patient at admissions, the Hospital also provides a reference to the policy in the first two billing invoices, as well as posting a reference to the policy in the admissions office and a summary on the website. |
| St. Luke's Hospital | Part V, Section B, Line 24: All individuals eligible under the hospital financial assistance policy (FAP) are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - Crosby Clinic | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 702 1st Street SW | AddressLine1Txt |
| City | Crosby | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58730 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | Clinic | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | The Hospital uses both an income-asset test and the federal poverty guidelines (FPG) located at http://aspe.hhs.gov/poverty to determine eligibility for financial assistance on medically emergent care claims. Medical indigency and insurance status are also used as factors to determine eligibility for financial assistance. |
| Part I, Line 7: | Financial assistance was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Medicaid and subsidized health services were determined using the Medicare cost report and applying the Medicare ratio of cost to charge for the respective cost centers. |
| Part I, Line 7g: | Part I, line 7g Subsidized Health Services includes $1,515,388 of cost related to a rural health clinic. |
| Part III, Line 2: | The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concession based on its historical collection experience with this class of patients and residents. |
| Part III, Line 3: | The estimated amount of implicit price concessions that is attributable to patients eligible under the organization's charity care policy is difficult to determine based on the high level of transient patients the facility cares for. The Hospital provides services to individuals that the Hospital lacks medical information or contact information for and thus cannot assess their ability to pay. It is estimated that approximately 9.5% of the implicit price concessions are from patients that could have qualified for charity care if they had applied. The 9.5% is the estimated poverty level of their primary service area, Divide County. |
| Part III, Line 4: | The financial statement footnote regarding implicit price concessions and bad debt may be found on pages 13-14 of the audited financial statements. |
| Part III, Line 8: | Medicare allowable cost is based on the Medicare cost report. The Medicare cost report is completed based on the rules & regulations set forth by Centers for Medicare and Medicaid Services. |
| Part III, Line 9b: | The Organization has a debt collection policy which applies to all patients. There is a series of five letters which are sent out to patients. The first two letters in the series state that the patient can apply for charity care. The remaining three letters in the series indicate that the individual will be sent to collections if the bill is not paid. Throughout the series of letters, the individual has the option to set up a payment plan in order to pay their bill.For those patients that are known to qualify for financial assistance all collection actions are ceased until the financial assistance application is completed and the Hospital works those patients through that process.St Luke's will provide written notice within 30 days before initiating extraordinary collection actions. The notice states there is financial assistance available, identifies the extraordinary collection actions they intend to initiate, and states a deadline after which extraordinary collection actions will be initiatied. St. Luke's will not initiate extraordinary collection actions until 120 days from the most recent episode of care when multiple episodes exist. Applications for financial assistance are available up to 12 months after the service. |
| Part VI, Line 2: | The Hospital sends out annual questionnaires to discover healthcare needs and wants for their service community. The Hospital conducted annual community blood draws, skin and colon screenings to discover current health care needs, as well as for a snapshot of the general knowledge of the future health of the community. |
| Part VI, Line 3: | The Hospital provides information on the eligibility for assistance by posting the policy in areas of emergent care patients, as well as sending a copy of the policy with the first two letters in a letter series to patients. This policy is also given out to patients who request information regarding financial assistance and upon admissions. |
| Part VI, Line 4: | St. Luke's primary service area consists of Divide and Burke counties which comprises of approximately 4,399 people. The population consists of 24.5% and 18.9%, respectively, of residents age 65 and over. There has been an overall growth in population due to the increase in the oil industry activity. The secondary service area is a small portion of Williams County and a small sector of Montana that surrounds the primary service area. Both Burke and Divide counties are HIPSA counties and are serviced by St. Luke's. The average household income in the primary service area is $51,208 and is $69,617 in the secondary area. In Divide county, the percentage of individuals living below the poverty rate is 9.5%. Burke county individuals living below the poverty rate is 15.4% for singles and 11.2% for families. There are 7 acute care facilities within the service area. St. Luke's is the only acute care hospital serving Divide County.With prior oil activity in the state, St. Luke's experienced a rapid increase in population, new businesses, housing projects and improved wage scales during previous years. These continued to drop as oil prices plummeted and the industry pulled back production and transportation in the fiscal year. |
| Part VI, Line 5: | St. Luke's works diligently to be a good steward for this community by providing jobs, health care, health information, elderly meals, and helping with the community infrastructure. St. Luke's Hospital conducts its business with the community and is a major customer for local businesses. The Hospital is a 20-bed acute care hospital and clinic that promotes the health of the community by providing a variety of health care services. The Hospital operates an emergency room open to all regardless of ability to pay. In addition, we provide pediatric care, swing bed, respite care for the elderly, procedure room, ambulatory, physical and occupational therapy, contracted speech therapy services, a contracted assisted living facility, and other services. A long-term care nursing facility was added in May 2013. It has capacity for 35 skilled-nursing beds. As of December 2019, basic care services were discontinued. As of September 2021, this facility closed. Nine of the current residents moved to live permanently into the non-skilled swingbed unit in the hospital. It is now called the Living Center. If there are surplus funds they are put back into the improvement of care for patients and used to contract with outside groups to provide hearing tests, CT, mammograms, and ultrasound. The organization extends medical staff privileges to other qualified physicians in the community. The staff belong to a diverse group of community organizations and the board is comprised of several members of the servicing community. As a sole community provider, the hospital provides an opportunity for the community to have a voice by allowing every citizen of the community to be a voting member at annual meetings. Other community connections include involvement on the Chamber of Commerce, which helps make the community financially healthy, and the DC EDC which works to improve the financial infrastructure of the community. St. Luke's provides 'Meals on Wheels' to those that would otherwise not be able to provide nutritious meals for themselves. Volunteers deliver the meals to the elderly and home bound. There were 2133 meals served during the fiscal year. We also provide the congregate meal three (3) nights per week for a total of 0 meals for this fiscal year. There were 3833 meals served to the assisted living units during the fiscal year. The Hospital also participates in the education process of medical professionals' studies at UND by creating tuition repayment programs for nurses and nursing students, as well as other medical disciplines. In addition, they also participate in government programs such as Medicare and Medicaid. The Hospital is active in health and patient wellness. They have provided the community with a wellness and education coordinator. Health education has also been provided throughout the community by way of quarterly news articles on a wide variety of health issues. We work with schools and each annual Hospital week we invite the 4th grade to the hospital for a tour of the Hospital. Physical Therapy has organized walks and runs for the community, as well as an annual wellness challenge to employees. Two community blood draws were held for reduced charges which checked individuals for PSA, Vitamin D, and diabetes. There were 332 draws during this period. There was also a free skin care clinic to check for suspicious skin abnormalities. A total of 35 screenings were done at the clinic. Colorectal cancer screening was done in April. There were 0 colorectal kits returned. Mammograms are arranged by our clinic for Trinity Health, who comes to the hospital monthly. Hearing checks are arranged and held at the hospital monthly by an outside facility. We provide some charity care in the form of direct write-offs and indirect write-offs of contractual bad debts and slow pays where we charge no interest even if the payment term is as much as 30 years. The hospital also coordinates with the St. Luke's Community Foundation to hold donated funds for effective use of donations. We have also added aquatic therapy pool to our services.In addition, we provide the use of our facility for the community blood drives, meetings for the Divide County Historical Society, Divide County Ambulance, border patrol education, hearing aid clinic, and the disaster planning committee at no charge. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Discretionary Spending Acct | Yes (X) | DiscretionarySpendingAcctInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| 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 (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jody Nelson | ||||||||||||||
| CEO | $178,517 | $0 | $0 | $0 | $0 | $0 | $5,355 | $0 | $0 | $0 | $183,872 | $0 | $0 | $0 |
| Benjamin Krogh | ||||||||||||||
| Physician | $256,457 | $0 | $0 | $0 | $0 | $0 | $8,104 | $0 | $22,253 | $0 | $286,814 | $0 | $0 | $0 |
| Christine Knudsvig | ||||||||||||||
| Family Nurse Practitioner | $233,743 | $0 | $0 | $0 | $0 | $0 | $4,271 | $0 | $10,349 | $0 | $248,363 | $0 | $0 | $0 |
| Stanley Stevens | ||||||||||||||
| Family Nurse Practitioner | $227,821 | $0 | $0 | $0 | $0 | $0 | $6,885 | $0 | $10,244 | $0 | $244,950 | $0 | $0 | $0 |
| James Hodges | ||||||||||||||
| Physician Assistan | $217,677 | $0 | $0 | $0 | $0 | $0 | $6,864 | $0 | $19,702 | $0 | $244,243 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 1a | FormAndLineReferenceDesc |
| Explanation | Discretionary spending account: CME (Continuing Medical Education) time. A doctor or nurse practitioner requests CME and he/she is paid the standard amount. The standard CME discretionary accounts are $2,500 for nurse practitioners and $3,000 for doctors. Spending for continuing education for the CEO is approved by a Board Officer and spending for continuing education for other staff is approved by the CEO. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Kari Ely | |||
| Family member of board member Wanda Ely | $28,508 | Employment | 0 |
| Laura Peterson | |||
| Family member of CFO Megan Peterson | $74,899 | Employment | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, line 3 | On July 1, 2021, the Hospital made the decision to discontinue operations of the Nursing Home which then closed on September 5, 2021. An impairment loss of $1,177,506 was recognized in 2022 for the Nursing Home property and equipment which is no longer being used. |
| Form 990, Part VI, Section A, line 6 | An individual is considered to be a voting member if they live in the service area. There is only one class of members. |
| Form 990, Part VI, Section A, line 7a | Each of the community voting members gets one vote regarding the election of the governing body. This takes place at the annual meeting. |
| Form 990, Part VI, Section A, line 8b | There were no committees with authority to act on behalf of the governing board. |
| Form 990, Part VI, Section B, line 11b | The CEO will review and approve a draft of the Form 990. A copy of the final version shall be distributed to the Board of Directors for their final approval prior to it being filed with the IRS. |
| Form 990, Part VI, Section B, line 12c | Our conflict of interest policy lies within our code of conduct policy and is geared to all employees and directors of St. Luke's Hospital and Clinic. Conflicts are reviewed and determined by the CEO. The policy states: It is the policy of St. Luke's Hospital & Clinics to prohibit its employees from engaging in any activity, practice, or act that conflicts with, or appears to conflict with, the interests of St. Luke's Hospital & Clinics, its patients or its suppliers. Therefore, employees must disclose any financial interest they or their immediate family have in any firm which does business with St. Luke's Hospital & Clinics or which competes with St. Luke's Hospital & Clinics. In addition, St. Luke's Hospital & Clinics may require divestiture of such interest if it deems the interest to be in conflict with its best interests. In addition to these standards on conflicts of interest, Directors of St. Luke's Hospital & Clinics are also subject to St. Luke's Hospital & Clinics' Conflict of Interest Policy. |
| Form 990, Part VI, Section B, line 15 | The Board approves salary increases and wage ranges for the CEO, COO, and all employees based upon comparability data, such as the NDHA survey and copies of comparable nonprofit organization's executive compensation. Discussion is held during a board meeting of independent persons and is documented in the meeting minutes. This action is completed on an annual basis. |
| Form 990, Part VI, Section C, line 19 | The governing documents, conflict of interest policy and financial statements are available upon request. They are also distributed at the annual meeting in order for all voting members of the community to have access to these documents. |
| Form 990, Part IX, line 11g | Contracted Services: Program service expenses 326,789. Management and general expenses 121,235. Fundraising expenses 0. Total expenses 448,024. Other Fees: Program service expenses 1,495. Management and general expenses 57,820. Fundraising expenses 0. Total expenses 59,315. Professional Fees: Program service expenses 1,270,250. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,270,250. |
| Form 990, Part XI, line 9: | Change in beneficial interest in charitable remainder unitrust 25,950. |