MCKENZIE COUNTY HEALTHCARE SYSTEMS INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- MCKENZIE COUNTY HEALTHCARE SYSTEMS INC (EIN 77-0637498)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-15
- IRS object ID
- 202341359349313744
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-15T15:53:36-05:00 | 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 | 770637498 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | McKenzie County Healthcare Systems Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MCKE | BusinessNameControlTxt |
| Phone | 7018423000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 709 4th Avenue NE | AddressLine1Txt |
| City | Watford City | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58854 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Peter Edis | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7018423000 | PhoneNum |
| Signature | 2023-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Peter | PersonFirstNm |
| Person Last | Edis | 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 | 2023-05-13 | 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 | Peter Edis | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 709 4th Avenue NE | AddressLine1Txt |
| City | Watford City | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58854 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $42,773,061 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.mckenziehealth.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2004 | FormationYr |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Activity Or Mission | Health care service provider. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 304 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $384,699 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $10,682,104 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,576,103 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $32,566,482 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $37,708,352 | CYProgramServiceRevenueAmt |
| PY Investment Income | $21,571 | PYInvestmentIncomeAmt |
| CY Investment Income | -$34,891 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$425,969 | PYOtherRevenueAmt |
| CY Other Revenue | -$434,822 | CYOtherRevenueAmt |
| PY Total Revenue | $42,844,188 | PYTotalRevenueAmt |
| CY Total Revenue | $41,814,742 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,000 | 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 | $18,974,597 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $19,164,181 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $24,520,454 | PYOtherExpensesAmt |
| CY Other Expenses | $25,820,880 | CYOtherExpensesAmt |
| PY Total Expenses | $43,496,051 | PYTotalExpensesAmt |
| CY Total Expenses | $44,985,061 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$651,863 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$3,170,319 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $109,663,436 | TotalAssetsBOYAmt |
| Total Assets EOY | $103,424,427 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $75,439,565 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $72,370,875 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $34,223,871 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $31,053,552 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Mckenzie County Healthcare Systems is a faith-based organization dedicated to professional, compassionate and quality healthcare. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $27,192,786 | ExpenseAmt |
| Revenue | $28,142,704 | RevenueAmt |
| Desc | McKenzie County Healthcare Systems provides 24 hour x 7 days a week services. MCHS provided in-patient, observation, and swing bed services - hospital - total inpatient/observation days - 1031. Total swing bed days - 836. MCHS offers various other services. They offer endoscopic exams once a month by a contracted provider. Total Outpatient Surgeries - 529. The emergency room is open 24 hours a day, 7 days a week. Total Emergency Room visits - 4,980, The laboratory is located within the Hospital facility. Birthday lab screenings are available to the community at the hospital at a reduced rate. Number of members taking advantage of Birthday Screenings - 1223. Total outpatient procedures - 26,146. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,509,738 | ExpenseAmt |
| Revenue | $5,065,702 | RevenueAmt |
| Desc | The McKenzie County Healthcare System (MCHS) Good Shepherd Home (GSH) is a 47-bed skilled nursing home with an attached 9-bed basic care unit. The GSH offers Day Care and/or Respite Care for those caring for a loved one in their home. A Dementia Support Group is offered to families. They maintain regular Resident Family Council Meetings. Along with qualified nursing care and staff, social services, physical therapy, occupational therapy, restoration nursing, laundry, housekeeping, beautician services, and activity programs are offered (beautician and activities held when COVID conditions allow). Visitors are welcome when COVID conditions allow; regular electronic "visits" are arranged otherwise. Pastoral care and chapel are offered 7 days a week. Activities include birthday parties, musical groups, baking, and bus trips. The Skilled Nursing total percent of occupancy has been 89%. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $6,107,473 | ExpenseAmt |
| Revenue | $3,711,787 | RevenueAmt |
| Desc | The MCHS Clinic (Rural Health Clinic) maintains the same mission as the Hospital. It provides care Monday through Friday. The RHC recently started conducting Telehealth visits as rendering providers due to COVID. A full-time contracted locum physician group provide Emergency Room Coverage at the hospital 24 hours a day x 7 days a week as well as 7 day a week Urgent Care coverage from 8a to 8p utilizing mid-level providers. An RHC provider offered regular visits to the Good Shepherd Home. Both the Value Based Program involvement as well as our Visiting Nurse Program have been a great asset to the clinic, providing care to homebound patients within our community. After the onset of the COVID-19 pandemic the RHC developed point-of-care services and rapid testing for the community. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $360,466 | ExpenseAmt |
| Revenue | $394,541 | RevenueAmt |
| Desc | Horizon Assisted Living provides assisted and independent living services. It consists of 15 apartments that provide a 24 hour call system to health care personnel. The staff is dedicated to helping seniors live at their highest level of independence and ability. Its percent of occupancy is currently at 90.6%. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $360,466 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $394,541 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $37,170,463 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | 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 | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | 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 | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 89 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 304 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | 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 | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Peter Edis | PersonNm |
| Phone | 7018423000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 709 4th Avenue NE | AddressLine1Txt |
| City | Watford City | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58854 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| Gary Brown | |||||||||
| Chair | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Neal Shipman | |||||||||
| Vice Chair | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Justin Voll | |||||||||
| Treasurer | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Jan Dodge | |||||||||
| Secretary | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Virginia Ceynar | |||||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| Tammy James | |||||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| Randy Quale | |||||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Monty Bulzomi | |||||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| Daniel Kelly | |||||||||
| CEO (thru Dec)/Fdtn President | 40.00 | 5.00 | Yes (X) | $415,551 | $0 | $19,511 | |||
| Peter Edis | |||||||||
| CEO (Start Jan 2022) | 40.00 | Yes (X) | $0 | $0 | $0 | ||||
| Micheal Curtis | |||||||||
| CAO (left July 2, 2021) | 40.00 | Yes (X) | $165,362 | $0 | $25,719 | ||||
| Greta McKenzie | |||||||||
| Interim CFO (Jan thru Jun 2021) | 40.00 | Yes (X) | $78,369 | $0 | $11,468 | ||||
| Cheryl Batchelor | |||||||||
| Interim CFO (Start Aug 2021) | 38.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| Cheryl Faulkner | |||||||||
| CNO | 40.00 | Yes (X) | $130,765 | $0 | $26,667 | ||||
| Gary Ramage | |||||||||
| Medical Director, Physicia | 32.00 | $353,613 | $0 | $46,452 | Yes (X) | ||||
| Ravindra Joshi | |||||||||
| Orthopedic Surgeon | 40.00 | $856,039 | $0 | $21,406 | Yes (X) | ||||
| Lucinda Mundorf | |||||||||
| Internal Medicine | 40.00 | $258,405 | $0 | $24,816 | Yes (X) | ||||
| Torfi Hoskuldsson | |||||||||
| General Surgeon | 40.00 | $221,317 | $0 | $45,177 | Yes (X) | ||||
| Maria Marchenko | |||||||||
| Pediatrician | 40.00 | $259,510 | $0 | $37,325 | Yes (X) | ||||
| Craig Smith | |||||||||
| Anesthesiologist | 40.00 | $264,778 | $0 | $3,532 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,003,709 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $262,073 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 28 | 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 |
|---|---|---|---|---|---|
| Acute Care Inc | |||||
| 1609 N Ankeny Blvd | Ankeny | IA | 50023 | Contract Physicials | $2,504,200 |
| Guardian Healthcare Providers | |||||
| PO Box 306098 | Nashville | TN | 37230 | Contract Workers | $1,614,635 |
| Equalize RCM Services | |||||
| PO Box 679005 | Dallas | TX | 75267 | Accounts Receivable Management | $1,391,143 |
| American Consultants | |||||
| 9359 W 75th St | Overland Park | KS | 66204 | Contract Workers | $1,247,498 |
| Sanford Health | |||||
| Lawson Building 5074 | Sioux Falls | SD | 57117 | Health Services | $1,004,538 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 15 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $2,568,265 | RelatedOrganizationsAmt |
| Government Grants | $1,520,897 | GovernmentGrantsAmt |
| All Other Contributions | $486,941 | AllOtherContributionsAmt |
| Total Contributions | $4,576,103 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Hospital Patient Service Revenue | 621110 | $27,803,605 | $27,803,605 |
| Nursing Home Service Revenue | 623000 | $5,065,702 | $5,065,702 |
| Clinic Service Revenue | 621110 | $3,711,787 | $3,711,787 |
| Assisted Living Rental | 623000 | $394,541 | $394,541 |
| 340B Pharmacy Revenue | 446110 | -$182,217 | -$182,217 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $914,934 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $521,316 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $393,618 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $37,708,352 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,635 | TotalRevenueColumnAmt |
| Exclusion | $17,635 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $470,971 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $905,793 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$434,822 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$434,822 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | -$8,919 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$425,903 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $52,526 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$52,526 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$52,526 | TotalRevenueColumnAmt |
| Exclusion | -$52,526 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $41,814,742 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $37,314,734 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $384,699 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$460,794 | 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 | $1,274,717 | TotalAmt |
| Program Services | $299,842 | ProgramServicesAmt |
| Management And General | $974,875 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $161,901 | TotalAmt |
| Management And General | $161,901 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,056,534 | TotalAmt |
| Program Services | $12,999,290 | ProgramServicesAmt |
| Management And General | $1,057,244 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $457,589 | TotalAmt |
| Program Services | $421,396 | ProgramServicesAmt |
| Management And General | $36,193 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,172,153 | TotalAmt |
| Program Services | $1,732,481 | ProgramServicesAmt |
| Management And General | $439,672 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,041,287 | TotalAmt |
| Program Services | $899,075 | ProgramServicesAmt |
| Management And General | $142,212 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,480 | TotalAmt |
| Management And General | $3,480 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,100 | TotalAmt |
| Management And General | $4,100 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,050,223 | TotalAmt |
| Program Services | $9,765,593 | ProgramServicesAmt |
| Management And General | $2,284,630 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $176,009 | TotalAmt |
| Program Services | $23,272 | ProgramServicesAmt |
| Management And General | $152,737 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $592,129 | TotalAmt |
| Program Services | $359,872 | ProgramServicesAmt |
| Management And General | $232,257 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $538,298 | TotalAmt |
| Program Services | $19,196 | ProgramServicesAmt |
| Management And General | $519,102 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $536,366 | TotalAmt |
| Program Services | $524,213 | ProgramServicesAmt |
| Management And General | $12,153 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,892 | TotalAmt |
| Program Services | $70,284 | ProgramServicesAmt |
| Management And General | $13,608 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,207 | TotalAmt |
| Program Services | $37,133 | ProgramServicesAmt |
| Management And General | $27,074 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,456,419 | TotalAmt |
| Program Services | $1,221,160 | ProgramServicesAmt |
| Management And General | $235,259 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,204,584 | TotalAmt |
| Program Services | $5,212,998 | ProgramServicesAmt |
| Management And General | $991,586 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $373,095 | TotalAmt |
| Program Services | $144,916 | ProgramServicesAmt |
| Management And General | $228,179 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $1,985,407 | $1,984,943 | $464 |
| Pharmaceuticals | $837,733 | $837,733 | |
| Food Service Supplies | $429,670 | $424,084 | $5,586 |
| Repairs and Maintenance | $134,207 | $130,426 | $3,781 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $351,061 | TotalAmt |
| Program Services | $62,556 | ProgramServicesAmt |
| Management And General | $288,505 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,985,061 | TotalAmt |
| Program Services | $37,170,463 | ProgramServicesAmt |
| Management And General | $7,814,598 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,812,686 | BOYAmt |
| EOY | $3,567,178 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,368,923 | BOYAmt |
| EOY | $6,695,536 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,962,343 | BOYAmt |
| EOY | $6,470,547 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,011,275 | BOYAmt |
| EOY | $1,017,730 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $459,133 | BOYAmt |
| EOY | $318,722 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $115,661,518 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $39,662,492 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,247,757 | BOYAmt |
| EOY | $75,999,026 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,656,259 | BOYAmt |
| EOY | $9,284,832 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $145,060 | BOYAmt |
| EOY | $70,856 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $109,663,436 | BOYAmt |
| EOY | $103,424,427 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,908,410 | BOYAmt |
| EOY | $3,349,923 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,517 | BOYAmt |
| EOY | $60,813 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $70,923,675 | BOYAmt |
| EOY | $68,925,139 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,545,963 | BOYAmt |
| EOY | $35,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,439,565 | BOYAmt |
| EOY | $72,370,875 | 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 | $34,223,871 | BOYAmt |
| EOY | $31,053,552 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,223,871 | BOYAmt |
| EOY | $31,053,552 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $109,663,436 | BOYAmt |
| EOY | $103,424,427 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$3,170,319 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $1,654 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,654 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The Organization is a member of North Dakota Hospital Association and North Dakota Long Term Care Association. A portion of membership dues to the above listed associations is used for lobbying. These associations advocate on behalf of its members for improving efficiency and accessibility of the healthcare delivery systems and the health status of North Dakota's population. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,144,947 | OtherCostOrOtherBasisAmt |
| Book Value | $1,144,947 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $55,569,792 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,367,116 | DepreciationAmt |
| Book Value | $40,202,676 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $52,297,873 | OtherCostOrOtherBasisAmt |
| Depreciation | $22,735,002 | DepreciationAmt |
| Book Value | $29,562,871 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,648,906 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,560,374 | DepreciationAmt |
| Book Value | $5,088,532 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $75,999,026 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Postretirement Benefit Obligation | Desc |
| Amt | $35,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $35,000 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $42,720,535 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $42,720,535 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$905,793 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$905,793 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $41,814,742 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $45,890,854 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $905,793 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $905,793 | ExpensesNotReportedAmt |
| Expenses Subtotal | $44,985,061 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $44,985,061 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 2b: | The Organizations holds security deposits, as well as resident trust funds. |
| Part X, Line 2: | The Health System believes it has appropriate support for any tax positions taken affecting the annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Health System 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 4b - Other Adjustments: | Rental Expenses Included in Expenses on Financials -905,793. |
| Part XII, Line 2d - Other Adjustments: | Rental Expenses Included in Revenue on Form 990 905,793. |
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 |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | 0 | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $124,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $124,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00280 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,028,129 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,952,707 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $75,422 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,152,129 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,952,707 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $199,422 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00450 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,562,561 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,842,111 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,720,450 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.19390 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,562,561 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,842,111 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,720,450 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.19390 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,714,690 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,794,818 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,919,872 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.19840 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $754,788 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $56,609 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,784,544 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,723,937 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $60,607 | 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 | McKenzie County Healthcare Systems Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 709 4th Ave NE | AddressLine1Txt |
| City | Watford City | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58854 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | http://mckenziehealth.com/ | WebsiteAddressTxt |
| State License | 5051A | 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 |
| Other | Swing bed unit, Urgent care, PT/OT | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | McKenzie County Healthcare Systems Inc | 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 | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | https://mckenziehealth.com/chna/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://mckenziehealth.com/chna/ | 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 | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| 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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://www.mckenziehealth.com/about/billing/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://www.mckenziehealth.com/about/billing/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://www.mckenziehealth.com/about/billing/ | 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 |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| 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 |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| McKenzie County Healthcare Systems Inc. | Part V, Section B, Line 5: Residents of the area were given the opportunity to participate in a survey. One hundred twenty-nine MCHS service area residents completed the survey. Additional information was collected through seven key informant interviews with community members. The input from the residents, who primarily reside in McKenzie County, represented the broad interests of the communities in the service area. Together with secondary data gathered from a wide range of sources, the survey presents a snapshot of the health needs and concerns in the community. A steering committee was responsible for planning and implementing the process. The committee consisted of the McKenzie County Courthouse Job Development Authority, a local bank Public Relations representative, the Chief of Ambulance at McKenzie County Ambulance, the Interim Director of Operations at MCHA, and the school Superintendent. |
| McKenzie County Healthcare Systems Inc. | Part V, Section B, Line 11: The most recent CHNA conducted in fiscal year 2022 identified the following significant needs:1. Availability of Primary Care Providers2. Availability of Specialists3. Not enough Affordable Housing4. Wellness and Disease PreventionThe organization will not be addressing the following needs identified due to limited financial and other resources:1. Not enough Affordable Housing2. Having enough childcare services3. Drug and Alcohol abuseDue to the timing on the completion of the fiscal year 2022 CHNA, the organization was not able to address any of the newly identified needs. The needs identified in the prior CHNA are as follows:1. Attracting and retaining a viable workforce and qualified medical providers2. Affordable Housing 3. Bullying/Cyber-bullying 4. Traffic Safety (speeding, road safety, drunk/distracted driving, seatbelt use) 5. Land Quality/Environmental Respect (litter, illegal dumping) 6. Domestic/Spouse Violence 6. Obesity/ Being OverweightActions taken during the current tax year to address the needs identified in the prior CHNA:1. The hospital is in the final negotiations for the hiring of a Family Medicine Physician2. The hospital has hired two general surgeons increasing general surgery capacity to 3+ weeks/month.3. The hospital has added ENT services one week per month.4. The hospital has opened an Obstetrics and Birthing unit.Actions taken in prior years to address the fiscal year 2019 CHNA needs that continued in the current tax year:1. We work collaboratively with the local domestic violence agency and have disseminated information to patients on how to get help. 2. Obesity is addressed through educating our patients on diabetes and healthy eating (we have a diabetic educator on staff). Our dietary department provides healthy, well-balanced meals to patients and staff. 3. Our organization allows staff to work flexible schedules and remotely when feasible to help lessen the need for costly childcare for our staff. We do not have resources outside of our internal staff.As the community's healthcare system, we support addressing health-related needs, but we will not have an active role in addressing Bullying/Cyber-bullying, Traffic Safety, or Land Quality/Environmental Respect as these are not within our purview as a health system. |
| McKenzie County Healthcare Systems Inc. | Part V, Section B, Line 16j: In addition to providing the full policy upon request, a summary of the policy is posted in the emergency rooms, waiting rooms, and admissions office. Upon admission, the patients receive a brochure in a packet referencing the financial assistance policy. The patients also receive information in their first billing invoice regarding the financial assistance policy. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Good Shepherd Home | ||||
| 709 4th Ave NE | Watford City | ND | 58854 | LT Care and Basic Care |
| 2 - McKenzie County Clinics | ||||
| 709 4th Ave NE | Watford City | ND | 58854 | Rural Health Clinic |
| 3 - McKenzie County Urgent Care Clinic | ||||
| 525 N Main St | Watford City | ND | 58854 | Urgent Care Clinic |
| 4 - Connie Wold Wellness Center | ||||
| 200 8th St NE | Watford City | ND | 58854 | Wellness Center |
| 5 - Horizon Assisted Living | ||||
| 705 4th Ave NE | Watford City | ND | 58854 | Assisted Living Facility |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | Charity care for Part I, line 7a was converted to cost by multiplying the ratio of cost to gross charges by the gross uncompensated charges associated with providing charity care to its patients.The costs for Medicaid in Part I, line 7b and Subsidized Health Services in Part I, line 7g were determined based on costs allocated to the relevant cost centers on the Medicare Cost Report. |
| Part I, Line 7g: | Subsidized health services includes costs of $2,409,223 from a provider based clinic, and $4,332,899 from a rural health clinic. |
| Part III, Line 2: | The amount reported on line 2 represents implicit price concessions. The Hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients. |
| Part III, Line 3: | The organization calculated Line 3 by multiplying the implicit price concessions by the percent of the population in the community that is below the Federal Poverty Guidelines. The percent of the population in the community that is below the Federal Poverty Guidelines is 7.5%. |
| Part III, Line 4: | The footnote to the Organization's financial statements can be found on pages 10 and 11 of the attached audited financial statements. |
| Part III, Line 8: | Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. |
| Part III, Line 9b: | The Organization does not collect on accounts that, at any point, have a financial assistance application in review or that has been approved. This is the practice even if the patient applies after the 240 days period after the date of the first invoice for the service. If the account is not completely written off (based on the sliding fee schedule), and they do not follow through on their payment plan for the balance, that would be the only time the account was outsourced to collections. Self pay patients are identified at the point of registration and receive a 35% write off.The Organization provides a copy of the plain language summary of the financial assistance policy with all billing statements and communications that occur within the first 120 days following the first billing statement. |
| Part VI, Line 2: | Separate evaluations are completed annually for the Critical Access Hospital and the Rural Health Clinic. At this time, services and statistics are reviewed. Each report is presented to the medical staff members and Board of Directors. Current services are discussed along with the needs not currently being met. Managers of each department annually review their services with the budgeting process and discuss possible projection of new services. Once a need is determined, it is discussed on a departmental level, and information is gathered and presented to the CEO/CFO for approval. MCHS holds their annual meeting for the public in the fall of each calendar year. This is an open meeting allowing the public to voice concerns and suggestions. |
| Part VI, Line 3: | The MCHS charity care policy is posted in the hospital and clinic admissions areas and emergency room. Copies of the policy and applications are available in each reception area of the hospital and clinic. Information is sent out to all patients with their first statement. If a bill is unpaid, after two statements have been sent, a billing employee will attempt to reach the responsible party by phone to discuss installment plans, charity care, and/or discuss various government benefits such as Medicaid. The MCHS business offices also have the applications at all times. The business office staff counsel anyone who presents themselves with overdue balances and present the above options. |
| Part VI, Line 4: | McKenzie County Healthcare Services serves McKenzie County. McKenzie County is the largest county in the state of North Dakota. It is very rural and includes part of the Fort Berthold Reservation. McKenzie County Hospital is the only healthcare system within a 45 mile radius. The McKenzie County Healthcare Systems, Inc. County's population was estimated in 2021 at 13,819. The median household income in 2021 was reported at $75,238. 7.5% of the population was reported below the poverty level in 2021. The rugged terrain, winter conditions, increased oil activity, and recreational activities have all added to the increased number of emergency room visits. With the recent oil activity in the state, McKenzie County is experiencing a rapid increase in population, new businesses, housing projects, and improved wage scales. With this rapid growth, MCHS is experiencing an influx in emergency room services, shortage of physicians and nurses, as well as growing bad debt expenses related to medical services provided to uninsured workers and patients that do not have a permanent residence to send bills to. |
| Part VI, Line 5: | The McKenzie County Board of Directors is made up of volunteer members from the local community of Watford City and the surrounding areas. MCHS does extend privileges to all physicians in the area. Specialists will also visit the local hospital and clinic to expand the present services. Surplus funds are applied for the purposes education, increasing patient services, wellness, and preventative care to its clients. MCHS is also a part of a worksite wellness North Dakota program. It allows their cardiac wellness manager (RN) to work closely in the state-wide program that can greatly improve the health of employees, resulting in lower health care costs, and increased productivity and morale. McKenzie County Healthcare Systems and the McKenzie County Healthcare Systems Benefit Fund together engaged in the building and funding of a wellness center. The wellness center opened in March 2013. The wellness center houses a physical therapy department to better utilize a therapy pool and has increased the present square footage of the hospital. Prevention is a key word today. The wellness center provides education and exercise to its members. It helps improve or prevent diseases like diabetes, high blood pressure, obesity, depression, and many not listed. In an effort to enhance services in the rural areas, McKenzie County Healthcare participates in several programs. The Rural Accountable Care Organization is intended to better serve our population by improving healthcare, patient satisfaction, and reducing costs while improving financial performance and sustainability. The Frontier Community Healthcare Integration Project (FCHIP) is a demonstration program that assists our Organization with providing telemedicine services to our population in order to provide access to more specialty services to the residents of our communities. These programs are aimed at increasing the integration and coordination of care amongst providers and improve the overall quality of care for our healthcare community.Our hospital provides charity care and other community benefits as defined by the IRS. But in addition, we believe that we provide a critically important community benefit which is not quantified. Our hospital, like most rural hospitals, was created and is maintained in order to provide local access to many health services: birthing center, diagnostics, emergency services and urgent care, home care, hospice, infusion services, inpatient care, laboratory services, occupational health, rehabilitation services, specialty medicine, speech and audiology, surgical services, and women's health. |
| Part VI, Line 6: | MCHS is an affiliate of Sanford Healthcare which assists the healthcare system with software and integrated equipment, ultimately streamlining healthcare across multiple states who use the same E.H.R. and other Sanford resources. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Written Policy Ref T And E Expnss | 0 | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | 0 | SubstantiationRequiredInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | 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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Ravindra Joshi | ||||||||||||||
| Orthopedic Surgeon | $854,934 | $0 | $625 | $0 | $480 | $0 | $7,489 | $0 | $13,917 | $0 | $877,445 | $0 | $0 | $0 |
| Daniel Kelly | ||||||||||||||
| CEO (thru Dec)/Fdtn President | $302,074 | $0 | $113,477 | $0 | $0 | $0 | $17,400 | $0 | $2,111 | $0 | $435,062 | $0 | $0 | $0 |
| Gary Ramage | ||||||||||||||
| Medical Director, Physicia | $347,226 | $0 | $6,387 | $0 | $0 | $0 | $17,400 | $0 | $29,052 | $0 | $400,065 | $0 | $0 | $0 |
| Maria Marchenko | ||||||||||||||
| Pediatrician | $258,885 | $0 | $625 | $0 | $0 | $0 | $15,360 | $0 | $21,965 | $0 | $296,835 | $0 | $0 | $0 |
| Lucinda Mundorf | ||||||||||||||
| Internal Medicine | $257,780 | $0 | $625 | $0 | $0 | $0 | $15,023 | $0 | $9,793 | $0 | $283,221 | $0 | $0 | $0 |
| Craig Smith | ||||||||||||||
| Anesthesiologist | $264,528 | $0 | $250 | $0 | $0 | $0 | $2,944 | $0 | $588 | $0 | $268,310 | $0 | $0 | $0 |
| Torfi Hoskuldsson | ||||||||||||||
| General Surgeon | $221,067 | $0 | $250 | $0 | $0 | $0 | $14,434 | $0 | $30,743 | $0 | $266,494 | $0 | $0 | $0 |
| Micheal Curtis | ||||||||||||||
| CAO (left July 2, 2021) | $120,362 | $0 | $0 | $0 | $45,000 | $0 | $7,594 | $0 | $18,125 | $0 | $191,081 | $0 | $0 | $0 |
| Cheryl Faulkner | ||||||||||||||
| CNO | $129,660 | $0 | $625 | $0 | $480 | $0 | $8,195 | $0 | $18,472 | $0 | $157,432 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 1a | Dan Kelly, CEO, received gross-up payments for bonuses. |
| Part I, Line 4a | Michael Curtis received a severance payment of $45,000 in calendar year 2021. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Leslie Kelly | |||
| Spouse of CEO | $80,543 | Employee salary | 0 |
| Samuel Kelly | |||
| Son of CEO | $81,358 | Employee salary | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 3 | The Interim CFO, Cheryl Batchellor, is paid by an unrelated management company, American Consultants, for her services to both the Benefit Fund of McKenzie County Healthcare Systems and McKenzie County Healthcare Systems (MCHS). In calendar year 2021, MCHS paid $291,200 for her services. |
| Form 990, Part VI, Section B, line 11b | The MCHS CEO and CFO review and approve the Form 990. The Board of Directors recieve a copy of the final Form 990 before it is filed with the IRS. |
| Form 990, Part VI, Section B, line 12c | An interested person is defined as any director, principal officer, and anyone who has a direct or indirect financial interest with respect to all entities in the healthcare system. An interested person must disclose the existence of the financial interest and will be given the opportunity to disclose all material facts to the Directors. The conflict will be reviewed by the remaining Board and will determine if a conflict exists. If a conflict exists, the interested person must abstain from voting on the issue and the remaining Board members will determine if the transaction is in the hospital's best interest, for its own benefit, and if it is fair and reasonable. This is accomplished through annual review and a signed statement stating that the interested person has obtained a copy of the policy and has read and understands the policy, and has agreed to comply with the policy. |
| Form 990, Part VI, Section B, line 15a | Members of the Board of Trustees review state-wide salary survey information and other Form 990s when determining any wage changes. The CEO has an annual evaluation completed. The CEO has the opportunity to give a proposal to the Board at their evaluation. Any change or revision is recorded in the Board minutes. An addendum to the terms of employment is signed by the Board President and CEO for the personnel file. The CEO approves other officer compensation based upon survey data on an annual basis. The results are documented in the officer's annual evaluation paperwork. |
| Form 990, Part VI, Section C, line 19 | The governing documents, conflict policy, and financial statements are available upon request. |
| Form 990, Part IX, line 11g | Service Contracts: Program service expenses 720,255. Management and general expenses 120,094. Fundraising expenses 0. Total expenses 840,349. Staffing Purchased Services: Program service expenses 7,606,905. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,606,905. Consulting: Program service expenses 69,070. Management and general expenses 0. Fundraising expenses 0. Total expenses 69,070. Contracted Physician and Medical: Program service expenses 525,989. Management and general expenses 0. Fundraising expenses 0. Total expenses 525,989. Other Purchased Services: Program service expenses 843,374. Management and general expenses 1,690,893. Fundraising expenses 0. Total expenses 2,534,267. Collection Agency: Program service expenses 0. Management and general expenses 306,490. Fundraising expenses 0. Total expenses 306,490. Consulting Services: Program service expenses 0. Management and general expenses 167,153. Fundraising expenses 0. Total expenses 167,153. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Benefit Fund of McKenzie County Healthcare Systems | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 709 4th Ave NE | AddressLine1Txt |
| City | Watford City | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58854 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363431210 | EIN |
| Primary Activities | To support the McKenzie County Healthcare Systems | PrimaryActivitiesTxt |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 7 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | McKenzie County Healthcare Systems Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | McKenzie County Healthcare Systems Properties | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 709 4th Ave NE | AddressLine1Txt |
| City | Watford City | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58854 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 462905447 | EIN |
| Primary Activities | Property Management | PrimaryActivitiesTxt |
| Legal Domicile State | ND | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | McKenzie County Healthcare Systems Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | $19,650 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $563,108 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Benefit Fund of McKenzie County Healthcare Systems | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $2,568,265 | InvolvedAmt |
| Method Of Amount Determination | Accrual | MethodOfAmountDeterminationTxt |