2023-05-01T11:34:21-05:00 2022-06-30 450250958 Eide Bailly LLP 1730 Burnt Boat Loop Ste 100 Bismarck ND 585030886 990 2021-07-01 450254692 St Lukes Hospital STLU 7019656384 702 1st Street SW PO Box 10 Crosby ND 58730 Jody Nelson CEO 7019656384 2023-05-01 1 Jody Nelson 999009999 Lisa Chaffee CPA P00193453 7012551091 2023-05-01 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Jody Nelson 702 1st Street SW PO Box 10 Crosby ND 58730 8789558 0 X www.dcstlukes.org X 1984 ND To provide health care services to Crosby and the surrounding area. 9 9 103 11 0 0 5698182 1568312 8637259 8524611 10123 -36292 0 -1310541 14345564 8746090 0 0 0 0 6648228 5353752 0 0 0 4867220 4479594 11515448 9833346 2830116 -1087256 11612014 9653668 7862610 6965570 3749404 2688098 X 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. 0 1 8366132 7214070 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. 8366132 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 18 0 1 103 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X Jody Nelson 7019656384 PO Box 10 Crosby ND 58730 Jerry King President 1.00 X X 0 0 0 Philip Johnson Vice President (Jul-Nov) 1.00 X X 0 0 0 Becky Knudson Dir (Jul-Nov)/VP (Dec-Jun) 1.00 X X 0 0 0 Jody Nelson CEO 40.00 X 178517 0 5355 Megan Peterson CFO starting Nov 2021 40.00 X 77098 0 3309 Loren Johnson Secretary/Treasurer 1.00 X X 0 0 0 Mark Holm Director 1.00 X 0 0 0 Benjamin Krogh Physician 40.00 X 256457 0 30357 Christine Knudsvig Family Nurse Practitioner 40.00 X 233743 0 14620 Stanley Stevens Family Nurse Practitioner 40.00 X 227821 0 17129 James Hodges Physician Assistan 40.00 X 217677 0 26566 Belinda Moen Care Center Administrator 40.00 X 105418 0 17838 Sandra Simonson Director 1.00 X 0 0 0 Wanda Ely Director 1.00 X 0 0 0 Ryan Wissbrod Director 1.00 X 0 0 0 Art Schilke Director 1.00 X 0 0 0 Kjell Vassen Director 1.00 X 0 0 0 1296731 0 115174 6 0 1 0 Primetime Healthcare LLC PO Box 3544 Omaha NE 68103 Travel Staffing Agency 376057 Fusion Medical Staffing PO Box 82674 Lincoln NE 68501 Travel Staffing Agency 331216 LRS Healthcare 11320 N 103 Plaze Omaha NE 68114 Travel Staffing Agency 162207 Avant Healthcare Professionals PO Box 744554 Atlanta GA 30374 Travel Staffing Agency 125208 Comtrix Solutions 23099 Red Sunset Place Aldie VA 20105 Travel Staffing Agency 108857 5 771047 797265 1568312 Patient Service Revenu 621110 8198463 8198463 340B Program 446110 186611 186611 Supporting Revenue 900099 106290 106290 Cafeteria 900099 33247 33247 8524611 7176 7176 43468 -43468 -43468 -43468 Discontinued NH Oper. 900099 -1310541 -1310541 -1310541 8746090 7214070 0 -36292 X 274352 274352 103407 103407 3983063 3766146 216917 117609 112807 4802 538806 479263 59543 336515 299327 37188 1777589 1598534 179055 9282 9282 127904 111981 15923 486739 412013 74726 15590 15590 32814 28750 4064 239544 200160 39384 496901 416827 80074 15672 4800 10872 Medical Supplies 513042 513042 Repairs and Maintenance 424783 146356 278427 Sales Tax 2159 2159 337575 157129 180446 9833346 8366132 1467214 0 3930174 1156212 153270 1026855 698855 212817 369085 55262 23621 13124265 8607160 5471973 4517105 679772 1269847 632090 235161 833583 11612014 9653668 874856 996641 31329 3802 5362335 5678696 1590288 290233 7862610 6965570 X 3732519 1965101 16885 722997 3749404 2688098 11612014 9653668 X -1087256 25950 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 83247 83247 9452905 5902084 3550821 2760502 2394994 365508 827611 310082 517529 4517105 Beneficial interest in charitable remainder trust 632090 F 632090 Receivable from St. Lukes Community Foundation 89183 Estimated Third Party Payor Settlements 744400 833583 CMS Advance Payments 290233 290233 X 8815508 25950 25950 8789558 -43468 -43468 8746090 9876814 43468 43468 9833346 0 9833346 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. 1 1 X 1 X 110.000000000000 1 X 1 1 0 0 42000 42000 0.00430 1562709 1471640 91069 0.00930 1604709 1471640 133069 0.01360 2448407 1917585 530822 0.05400 2448407 1917585 530822 0.05400 4053116 3389225 663891 0.06760 1 11744 1116 3828607 3808278 20329 X 1 1 1 1 St Luke's Hospital 702 1st St SW Crosby ND 58730 www.dcstlukes.org 5011 X X X X St Luke's Hospital 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X www.dcstlukes.org/resources X X 1 21 1 www.dcstlukes.org/resources 0 1 X 110.000000000000 200.000000000000 X X X X 1 1 X X X X X 1 X www.dcstlukes.org/resources X www.dcstlukes.org/resources X www.dcstlukes.org/resources X X X X X X 1 X 0 X X X X 1 X 0 1 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. 1 1 - Crosby Clinic 702 1st Street SW Crosby ND 58730 Clinic 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. X 1 1 X X 0 0 0 0 0 0 0 0 0 Jody Nelson CEO 178517 0 0 0 0 0 5355 0 0 0 183872 0 0 0 Benjamin Krogh Physician 256457 0 0 0 0 0 8104 0 22253 0 286814 0 0 0 Christine Knudsvig Family Nurse Practitioner 233743 0 0 0 0 0 4271 0 10349 0 248363 0 0 0 Stanley Stevens Family Nurse Practitioner 227821 0 0 0 0 0 6885 0 10244 0 244950 0 0 0 James Hodges Physician Assistan 217677 0 0 0 0 0 6864 0 19702 0 244243 0 0 0 Part I, Line 1a 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. Kari Ely Family member of board member Wanda Ely 28508 Employment 0 Laura Peterson Family member of CFO Megan Peterson 74899 Employment 0 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.