LAKE VIEW MEMORIAL HOSPITAL INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- LAKE VIEW MEMORIAL HOSPITAL INC (EIN 41-0786046)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-10-28
- IRS object ID
- 202113019349302041
- Schema version
- 2020v4.1
- 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 K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-10-28T16:21:58-05:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 S 6TH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410786046 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKE VIEW MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LAKE | BusinessNameControlTxt |
| Phone | 2188347300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 325 11TH AVENUE | AddressLine1Txt |
| City | TWO HARBORS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55616 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ERIC LOHN | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 2188347300 | PhoneNum |
| Signature | 2021-10-27 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | ERIC | PersonFirstNm |
| Person Last | LOHN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DARRYN MCGARVEY | PreparerPersonNm |
| PTIN | P00958683 | PTIN |
| Phone | 6123764500 | PhoneNum |
| Preparation | 2021-10-27 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | GREG RUBERG | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 325 11TH AVENUE | AddressLine1Txt |
| City | TWO HARBORS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55616 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $23,858,109 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.LVMHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1955 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | SERVE AS THE LEADING PROVIDER OF QUALITY HEALTHCARE SERVICES TO LAKE COUNTY AND THE SURROUNDING AREA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 162 | TotalEmployeeCnt |
| Total Volunteers | 7 | TotalVolunteersCnt |
| Total Gross UBI | $286,597 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $97,896 | PYContributionsGrantsAmt |
| CY Contributions Grants | $801,652 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $18,478,304 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $18,536,988 | CYProgramServiceRevenueAmt |
| PY Investment Income | $679,879 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,165,201 | CYInvestmentIncomeAmt |
| PY Other Revenue | $247,896 | PYOtherRevenueAmt |
| CY Other Revenue | $211,724 | CYOtherRevenueAmt |
| PY Total Revenue | $19,503,975 | PYTotalRevenueAmt |
| CY Total Revenue | $20,715,565 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $18,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $892 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,764,241 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,738,053 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,012,802 | PYOtherExpensesAmt |
| CY Other Expenses | $8,630,529 | CYOtherExpensesAmt |
| PY Total Expenses | $17,795,043 | PYTotalExpensesAmt |
| CY Total Expenses | $17,369,474 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,708,932 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,346,091 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $29,698,692 | TotalAssetsBOYAmt |
| Total Assets EOY | $43,364,236 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $9,565,218 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $20,072,083 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $20,133,474 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $23,292,153 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE PATIENT ABOVE ALL ELSE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $14,689,298 | ExpenseAmt |
| Grant | $892 | GrantAmt |
| Revenue | $19,414,336 | RevenueAmt |
| Desc | LAKE VIEW MEMORIAL HOSPITAL, INC. (LAKE VIEW) OPERATES HEALTH CARE FACILITIES AND RELATED PROGRAMS INCLUDING A HOSPITAL, AMBULATORY SURGERY, URGENT CARE, AND PHYSICIAN CLINICS IN TWO HARBORS, MN AND SILVER BAY, MN FOR THE BENEFIT OF LAKE COUNTY AND THE SURROUNDING COMMUNITIES. IN FURTHERANCE OF ITS CHARITABLE PURPOSE, LAKE VIEW PROVIDES A VARIETY OF BENEFITS TO THE COMMUNITY, INCLUDING OFFERING VARIOUS COMMUNITY-BASED SERVICE PROGRAMS AND DONATING SPACE FOR USE BY COMMUNITY GROUPS. ADDITIONALLY, A NUMBER OF HEALTH-RELATED EDUCATIONAL PROGRAMS ARE PROVIDED FOR THE BENEFIT OF THE COMMUNITY, INCLUDING SPONSORING A HIGH SCHOOL SCIENCE CLASS AND PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARD OF HEALTH IN THE COMMUNITY. THE HOSPITAL ALSO PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED RATES TO RESIDENTS OF THE COMMUNITY, PRIMARILY THE UNINSURED AND PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT ARE UNABLE DUE TO SOCIO-ECONOMIC FACTORS. | Desc |
| Total Program Service Expenses | $14,689,298 | 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 | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | 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 | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 6 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 162 | 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | 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 | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | 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 | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NATHAN CAVALLIN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2188347300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 325 11TH AVENUE | AddressLine1Txt |
| City | TWO HARBORS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55616 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 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 | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| KEVIN NOKELS TREASURER | ||||||||
| ST. LUKE'S HOSP PRESIDENT/CEO | 2.00 | 38.00 | Yes (X) | Yes (X) | $0 | $661,922 | $171,953 | |
| ERIC LOHN TREASURER | ||||||||
| ST. LUKE'S HOSP CFO | 2.00 | 38.00 | Yes (X) | Yes (X) | $0 | $625,178 | $117,642 | |
| NICHOLAS VAN DEELEN MD | ||||||||
| ST. LUKE'S HOSP CMO | 2.00 | 38.00 | Yes (X) | $0 | $385,425 | $112,139 | ||
| GREG RUBERG | ||||||||
| PRESIDENT/CEO | 35.00 | 5.00 | Yes (X) | $0 | $209,583 | $30,066 | ||
| ELIZABETH FEIST MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $169,426 | $0 | $27,153 | Yes (X) | ||
| E TOLGA HANHAN MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $175,253 | $0 | $17,571 | Yes (X) | ||
| KELSEY SCHULTZ MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $162,142 | $0 | $3,995 | Yes (X) | ||
| LAURA HASE MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $139,505 | $0 | $24,220 | Yes (X) | ||
| SHAWN MCMAHON MD | ||||||||
| DIRECTOR & PHYSICIAN | 40.00 | 0.00 | Yes (X) | $142,272 | $0 | $18,715 | ||
| TOM PETERSON MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $138,360 | $0 | $10,323 | Yes (X) | ||
| RICK HOGENSON | ||||||||
| CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JANELLE JONES | ||||||||
| VICE CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KEVIN BEARDSLEY | ||||||||
| SECRETARY | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| GORDY ANDERSON | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JOHN CLOUTIER | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CHRIS KUSTRITZ | ||||||||
| DIRECTOR (THROUGH 3/2020) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| WADE LEBLANC | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JOYCE SCOTT | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $926,958 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,882,108 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $533,777 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 12 | 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 |
|---|---|---|---|---|---|
| KRAUS ANDERSON CONSTRUCTION COMPANY | |||||
| 501 SOUTH 8TH STREET | MINNEAPOLIS | MN | 55404 | CONSTRUCTION & CONSTRUCTION MANAGEMENT S | $9,631,521 |
| ST LUKE'S HOSPITAL OF DULUTH | |||||
| 915 E 1ST STREET | DULUTH | MN | 55805 | MANAGEMENT SERVICES | $1,922,000 |
| WAPITI MEDICAL GROUP | |||||
| 107 FLYNN DRIVE SUITE 600 | MILBANK | SD | 57252 | EMERGENCY ROOM PHYSICIAN SERVICES | $1,515,565 |
| AGILITI HEALTH INC | |||||
| PO BOX 851313 | MINNEAPOLIS | MN | 55485 | MEDICAL EQUIPMENT RENTAL & REPAIR | $466,703 |
| GE HEALTHCARE | |||||
| 2984 COLLECTIONS CENTER DRIVE | CHICAGO | IL | 60693 | MEDICAL IMAGING EQUIPMENT | $192,370 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 13 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $418,266 | GovernmentGrantsAmt |
| All Other Contributions | $383,386 | AllOtherContributionsAmt |
| Total Contributions | $801,652 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT SERVICES | 621500 | $18,277,920 | $18,086,437 | $191,483 |
| OTHER ANCILLARY SERVICES | 713940 | $259,068 | $247,366 | $11,702 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $18,536,988 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $84,668 | TotalRevenueColumnAmt |
| Exclusion | $84,668 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,223,077 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,142,544 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,080,533 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,080,533 | TotalRevenueColumnAmt |
| Exclusion | $1,080,533 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| MEALS REVENUE | 624210 | $111,471 | $83,412 | $28,059 |
| MISCELLANEOUS INCOME | 900099 | $100,253 | $100,253 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $211,724 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,715,565 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $18,333,803 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $286,597 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,293,513 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $892 | TotalAmt |
| Program Services | $892 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $400,636 | TotalAmt |
| Program Services | $396,630 | ProgramServicesAmt |
| Management And General | $4,006 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,378,807 | TotalAmt |
| Program Services | $5,298,505 | ProgramServicesAmt |
| Management And General | $1,080,302 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $139,593 | TotalAmt |
| Program Services | $115,952 | ProgramServicesAmt |
| Management And General | $23,641 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,337,249 | TotalAmt |
| Program Services | $1,110,775 | ProgramServicesAmt |
| Management And General | $226,474 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $481,768 | TotalAmt |
| Program Services | $400,177 | ProgramServicesAmt |
| Management And General | $81,591 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,440 | TotalAmt |
| Management And General | $4,440 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,107 | TotalAmt |
| Management And General | $67,107 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,913,304 | TotalAmt |
| Program Services | $3,250,555 | ProgramServicesAmt |
| Management And General | $662,749 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $410,668 | TotalAmt |
| Program Services | $341,118 | ProgramServicesAmt |
| Management And General | $69,550 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $400,896 | TotalAmt |
| Program Services | $333,001 | ProgramServicesAmt |
| Management And General | $67,895 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,444 | TotalAmt |
| Program Services | $50,207 | ProgramServicesAmt |
| Management And General | $10,237 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $213,127 | TotalAmt |
| Program Services | $177,032 | ProgramServicesAmt |
| Management And General | $36,095 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $812,867 | TotalAmt |
| Program Services | $675,202 | ProgramServicesAmt |
| Management And General | $137,665 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,675 | TotalAmt |
| Program Services | $32,956 | ProgramServicesAmt |
| Management And General | $6,719 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $759,635 | $759,635 | |
| MISCELLANEOUS EXPENSES | $470,029 | $390,426 | $79,603 |
| BAD DEBT EXPENSE | $437,955 | $437,955 | |
| REPAIRS & MAINTENANCE | $363,237 | $301,720 | $61,517 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $677,145 | TotalAmt |
| Program Services | $616,560 | ProgramServicesAmt |
| Management And General | $60,585 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,369,474 | TotalAmt |
| Program Services | $14,689,298 | ProgramServicesAmt |
| Management And General | $2,680,176 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,580,208 | BOYAmt |
| EOY | $7,302,532 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,816,905 | BOYAmt |
| EOY | $5,165,018 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,723,948 | BOYAmt |
| EOY | $3,640,696 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $442,256 | BOYAmt |
| EOY | $459,038 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $219,621 | BOYAmt |
| EOY | $146,175 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $29,014,461 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $9,668,809 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,975,070 | BOYAmt |
| EOY | $19,345,652 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,340,241 | BOYAmt |
| EOY | $6,577,919 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $600,443 | BOYAmt |
| EOY | $727,206 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,698,692 | BOYAmt |
| EOY | $43,364,236 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,755,440 | BOYAmt |
| EOY | $5,608,385 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,640,775 | BOYAmt |
| EOY | $8,342,836 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,775,003 | BOYAmt |
| EOY | $1,671,996 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $394,000 | BOYAmt |
| EOY | $4,448,866 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,565,218 | BOYAmt |
| EOY | $20,072,083 | 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 | $19,852,337 | BOYAmt |
| EOY | $23,011,016 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $281,137 | BOYAmt |
| EOY | $281,137 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,133,474 | BOYAmt |
| EOY | $23,292,153 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,698,692 | BOYAmt |
| EOY | $43,364,236 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,346,091 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$315,043 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $127,631 | 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 | $708 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $708 | 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 | A PORTION OF THE MEMBERSHIP DUES THAT LAKE VIEW MEMORIAL HOSPITAL PAYS TO THE MINNESOTA HOSPITAL ASSOCIATION ARE USED BY THE ASSOCIATION TO ADVOCATE ON BEHALF OF THE HOSPITAL REGARDING ISSUES RELATING TO HEALTH CARE | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $281,137 | BeginningYearBalanceAmt |
| End Year Balance | $281,137 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $281,137 | BeginningYearBalanceAmt |
| End Year Balance | $281,137 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $281,137 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $2,974 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $2,974 | OtherExpendituresAmt |
| End Year Balance | $281,137 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $281,137 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,905 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,905 | OtherExpendituresAmt |
| End Year Balance | $281,137 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $281,137 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $2,189 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $2,189 | OtherExpendituresAmt |
| End Year Balance | $281,137 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $302,335 | OtherCostOrOtherBasisAmt |
| Book Value | $302,335 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,344,691 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,111,123 | DepreciationAmt |
| Book Value | $17,233,568 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $279,391 | OtherCostOrOtherBasisAmt |
| Depreciation | $202,102 | DepreciationAmt |
| Book Value | $77,289 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,088,044 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,355,584 | DepreciationAmt |
| Book Value | $1,732,460 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $19,345,652 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CARES ACT ACCELERATED PAYMENTS | Desc |
| Amt | $4,448,866 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,448,866 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | ANY EARNINGS OF THE ENDOWMENT FUND ARE USED EXCLUSIVELY TO SUPPORT HOSPITAL OPERATIONS. |
| PART X, LINE 2: | LAKE VIEW MEMORIAL HOSPITAL IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) THAT IS EXEMPT FROM FEDERAL INCOME TAXES ON UNRELATED INCOME PURSUANT TO SECTION 501(C)(3) OF THE IRC. THE HOSPITAL HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE HOSPITAL FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. THE HOSPITAL'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. |
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 |
| Percent300 | Yes (X) | Percent300Ind |
| 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 | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $441,697 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $441,697 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02610 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,796,676 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,229,365 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $567,311 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03350 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,238,373 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,229,365 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,009,008 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05960 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $115,368 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $83,412 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $31,956 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $89,140 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $89,140 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00530 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $204,508 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $83,412 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $121,096 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00720 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,442,881 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,312,777 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,130,104 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06680 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,516 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,516 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,989 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,989 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,505 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,505 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $437,955 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,405,348 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,889,647 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,484,299 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKE VIEW MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 325 11TH AVENUE | AddressLine1Txt |
| City | TWO HARBORS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55616 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.LVMHOSPITAL.COM | WebsiteAddressTxt |
| State License | 395319 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKE VIEW MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | SEE LINE 7D | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE LINE 7D | 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 | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| 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 | SEE PART V, SECTION B, LINE 16J | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, SECTION B, LINE 16J | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, SEC B, LINE 16J | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| 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 Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| LAKE VIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN FOUR STAGES: ASSESSMENT, PRIORITIZATION, DESIGN & FINALIZATION. THROUGH EACH PHASE OF THE ASSESSMENT PROCESS, A COLLABORATIVE COMMUNITY ASSESSMENT TEAM WAS ASKED TO REVIEW THE DATA, PRIORITIZATION & RESULTS OF COMMUNITY FOCUS GROUPS TO MAXIMIZE THE RELEVANCE OF THE ASSESSMENT. THIS GROUP INCLUDED REPRESENTATION FROM LAKE VIEW, ST. LUKE'S, LAKE COUNTY PUBLIC HEALTH & HUMAN SERVICES, THE CARLTON-COOK-LAKE-ST. LOUIS COMMUNITY HEALTH BOARD, LAKE SUPERIOR SCHOOL DISTRICT AND NON-PROFIT ORGANIZATIONS THAT WORK WITH UNDERSERVED COMMUNITIES IN LAKE COUNTY OR IN THE AREA SERVED BY LAKE VIEW HOSPITAL. |
| LAKE VIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6A: ST LUKE'S HOSPITAL OF DULUTH |
| LAKE VIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6B: LAKE COUNTY PUBLIC HEALTH, LAKE SUPERIOR SCHOOL DISTRICT, THE CARLTON-COOK-LAKE-ST. LOUIS COMMUNITY HEALTH BOARD, OTHER LOCAL NON-PROFIT ORGANIZATIONS |
| LAKE VIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 7D: THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT WWW.SLHDULUTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/. |
| LAKE VIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: THE NEEDS CHOSEN (MENTAL HEALTH, ALCHOL/TOBACCO/DRUGS AND HEALTY LIFESTYLES) ARE DIRECTLY RELATED TO THE HEALTH NEEDS IDENTIFIED BELOW. THE POPULATIONS FOR THE CHOSEN HEALTH NEEDS OVERLAP TO A LARGE DEGREE WITH THOSE OF THE NON-SELECTED HEALTH NEEDS: 1. MENTAL HEALTH ISSUES IN YOUTH AND ADULTS 2. ALCOHOL/TOBACCO/DRUGS; SPECIFICALLY VAPING IN ADOLESCENTS AND YOUNG ADULTS3. ALCOHOL/TOBACCO/DRUGS; SPECIFICALLY OPIOID USE IN ADULTS4. HEALTHY LIFESTYLES; SPECIFICALLY FOOD ACCESS/INSECURITY5. HEALTHY LIFESTYLES; SPECIFICALLY PHYSICAL ACTIVITY THE SYSTEM BELIEVES IT HAS THE BEST OPPORTUNITY TO POSITIVELY IMPACT A LARGER PORTION OF THE POPULATION WITH THE NEEDS SELECTED. PROGRESS TO DATE ON THE 2019/2020 COMMUNITY HEALTH NEEDS ASSESSMENT ARE AS FOLLOWS:PRIORITY 1: MENTAL HEALTH - LAKE VIEW HIRED A BEHAVIORAL HEALTH NURSE PRACTIONER TO PRACTICE IN ITS ON-CAMPUS PRIMARY CARE CLINIC. THIS PROVIDER OFFERS MENTAL HEALTH FIRST AID TRAINING TO STAFF AND COMMUNITY MEMBERS, HOSTS WELLNESS FAIRS AND WORKS CLOSELY WITH PRIMARY CARE PROVIDERS TO SUPPORT PATIENT CARE AND IDENTIFY PATIENTS WHO COULD SPECIFICALLY BENEFIT FROM BEHAVIORAL HEALTH SERVICES. ADDITIONALLY, THROUGH A PARTNERSHIP WITH THE HUMAN DEVELOPMENT CENTER, THE COMMUNITY HAS ACCESS TO COUNSELING/THERAPY SERVICES, PSYCHIATRY, MOBILE CRISIS RESPONSE AND EDUCATIONAL EVENTS. PRIORITY 2: VAPING - ONE OF LAKE VIEW'S PRIMARY CARE NURSE PRACTIONERS BECAME CERTIFIED IN TOBACCO CESSATION, WHICH INCLUDES VAPING, AND WAS FEATURED BY LOCAL HIGH SCHOOLS IN EDUCATIONAL SEMINARS IN ADDITION TO CREATING EDUCATIONAL/SOCIAL MEDIA MATERIAL ADDRESSING THE VAPING ISSUES PREVALENT IN ADOLESCENTS IN THE COMMUNITY.PRIORITY 3: OPIOID USE - LAKE VIEW DEVELOPED AND IMPLEMENTED STANDARDIZED TOOLS FOR OPIOID ASSESSMENT, INTERVENTION AND DOCUMENTATION IN THE OUTPATIENT SETTING. ADDITIONALLY, LAKE VIEW MODIFIED ITS PRESCRIBING PRACTICES TO PROMOTE/ENHANCE THE USE OF NON-PHARMACOLOGICAL THERAPIES FOR PAIN MANAGEMENT. FURTHERMORE, THROUGH COMMUNITY EDUCATION AND PARTNERSHIPS WITH LOCAL LAW ENFORCEMENT LAKE VIEW STRIVES TO REDUCE OPIOID USAGE/ABUSE IN THE COMMUNITY.PRIORITY 4: FOOD ACCESS/INSECURITY - LAKE VIEW CONTRACTS WITH LOCAL AEOA TO PROVIDE HEALTHY MEALS FOR SENIORS VIA "MEALS ON WHEELS AND "CONGREGATE DINING" PROGRAMS. LAKE VIEW ALSO PARTNERS WITH LAKE COUNTY WIC TO PROVIDE DIETICIAN SERVICES INCLUDING NUTRITION EDUCATION. FURTHER GOALS FOR LAKE VIEW INCLUDE AN ON-CAMPUS RENOVATION OF THE KITCHEN, CAFETERIA AND DINING SPACES TO PROVIDE MORE HEALTHY OPTIONS, AS WELL AS CREATING COMMUNITY GARDEN SPACE NOT ONLY FOR AN OPPORTUNITY FOR COMMUNITY OUTDOOR ACTIVITY AND STRESS REDUCTION, BUT TO PROMOTE PRODUCE INTAKE AND ADDRESS FOOD INSECURITY. LAKE VIEW NUTRITION SERVICES STAFF ALSO PREPARE AND PROVIDE HEALTHY SNACKS FOR YOUTH EVENTS THROUGHOUT THE YEAR. PRIORITY 5: PHYSICAL ACTIVITY - LAKE VIEW'S FITNESS CENTER OFFERS WAIVERS FOR LOW INCOME INDIVIDUALS AS WELL AS FREE FITNESS CENTER MEMBERSHIPS AS DOOR PRIZES AND SILENT AUCTION ITEMS TO VARIOUS COMMUNITY FUNDRAISERS AND COMMUNITY EVENTS. DIETARY AND REHAB STAFF ARE ALSO FEATURED PRESENTORS WITH THE LOCAL AGING MASTERY PROGRAM. LAKE VIEW'S PHYSICAL THERAPY & FITNESS CENTER LOCATION IN THE WILLIAM KELLEY HIGH SCHOOL IN SILVER BAY CONTINUTES TO PROVIDE ACCESS TO A VARIETY OF HIGH-QUALITY EXERCISE EQUIPMENT TO THE COMMUNITY, SCHOOL STUDENTS, ATHLETES, STAFF AND COACHING PERSONNEL. THE STAFFING AND SUPERVISION OF THE FITNESS CENTER IS COVERED BY LAKE VIEW DURING FITNESS CENTER HOURS. LAKE VIEW OFFERS ONE-TIME CONSULTATIONS FREE OF CHARGE WITH A PHYSICAL THERAPIST OR EXERCISE PHYSIOLOGIST TO SET UP INDEPENDENT EXERCISE PROGRAMS IN THE FITNESS CENTER. THIS PROGRAM IS TAILORED TO ENSURE THAT INDIVIDUALS ARE PERFORMING SAFE AND APPROPRIATE EXERCISE REGIMENS TO INCREASE PHYSICAL ACTIVITY AND PREVENT OBESITY. THE FOCUS OF THE CONSULTATION IS TO INDIVIDUALIZE A FITNESS PROGRAM TO HELP CLIENTS REACH THEIR PERSONAL GOALS INCLUDING IMPROVED FITNESS AND/OR WEIGHT LOSS. LAKE VIEW REHAB ALSO PROVIDES A FREE WEIGHT LIFTING AND CONDITIONING CLASS TO HIGH SCHOOL STUDENTS THAT PROMOTES STUDENT HEALTH AND WELLNESS. A PHYSICAL THERAPIST PROVIDES THIS HOUR LONG WEIGHT CLASS TWICE A WEEK. LAKE VIEW SUPPORTS LOCAL 5K/10K WALK-RUN EVENTS AND HOSTS A VARIETY OF PHYSICAL ACTIVITY CLASSES ON-CAMPUS, INCLUDING A STRENGTH AND FLEXIBILITY CLASS LED BY TRAINED COMMUNITY VOLUNTEERS AND A YOGA CLASS LED BY A PHYSICAL THERAPIST. THIS IS AN ONGOING CLASS SCHEDULE THAT HAS BEEN OFFERED FOR THE PAST 6+ YEARS. FUTURE PLANS TO IMPROVE COMMUNITY PHYSICAL ACTIVITY INCLUDE PARTNERSHIPS WITH LOCAL BIKE TRAIL INITIATIVES, CONSIDERATION OF 24 HOUR ACCESS TO FITNESS CENTER FOR EMPLOYEES, COLLABORATION WITH NEARBY STATE PARKS WELLNESS EVENTS, INCREASED OPTIONS FOR FITNESS CLASSES ON-CAMPUS AND THROUGH COMMUNITY EDUCATION AND IMPROVED ONLINE PRESENCE TO PUBLICIZE ALL HOSPITAL-SPONSORED HEALTH AND WELLNESS EVENTS AND CLASSES. |
| LAKE VIEW MEMORIAL HOSPITAL | PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY, APPLICATION, AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE ONLINE AT WWW.SLHDULUTH.COM/PATIENTS-VISITORS/FINANCIAL-SERVICES/LAKE-VIEW- FINANCIAL-ASSISTANCE-PROGRAM/. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - LAKE VIEW SILVER BAY MEDICAL CLINIC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 OUTER DRIVE | AddressLine1Txt |
| City | SILVER BAY | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55614 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | OUTPATIENT PRIMARY CARE CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | A FINANCIAL ASSISTANCE DETERMINATION WILL BE MADE AS SOON AS POSSIBLE AFTER A COMPLETE "COMMON FINANCIAL CARE APPLICATION FORM" HAS BEEN SUBMITTED. THE APPLICATION WILL BE UTILIZED TO EVALUATE A PATIENT'S FINANCIAL RESOURCES AND OBLIGATIONS AND REQUIRES THAT THE PATIENT PROVIDE COPIES OF DOCUMENTS SUPPORTING THE FOLLOWING INFORMATION: EARNED INCOME INCLUDING MONTHLY GROSS WAGES, SALARY, AND SELF-EMPLOYMENT INCOME; UNEARNED INCOME INCLUDING DIVIDENDS, INTEREST AND INCOME FROM ANY OTHER SOURCE SUCH AS UNEMPLOYMENT OR WORKERS COMPENSATION; NUMBER OF DEPENDENTS IN THE HOUSEHOLD; INFORMATION TO DETERMINE THE PATIENT'S FINANCIAL STATUS, INCLUDING ASSETS AND LIABILITIES. A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON THE VALUE OF THEIR INCOME AND ASSETS COMPUTED ON THE "INCOME/ASSET VALUE CALCULATION WORKSHEET" AS COMPARED TO A MULTIPLE OF THE CURRENT "FEDERAL POVERTY GUIDELINE". THE ASSISTANCE PROGRAM QUALIFICATIONS ARE BASED ON A SLIDING SCALE: A 100% DISCOUNT IF HOUSEHOLD INCOME IS LESS THAN 100% OF THE FEDERAL POVERTY GUIDELINES (FPG), A 90% DISCOUNT IF HOUSEHOLD INCOME IS BETWEEN 101% AND 150% OF FPG, A 75% DISCOUNT IF HOUSEHOLD INCOME IS BETWEEN 151% AND 200% OF FPG, A GREATER OF AMOUNTS GENERALLY BILLED OR 50% DISCOUNT IF HOUSEHOLD INCOME IS BETWEEN 201% AND 300% OF FPG. THE VALUE OF ASSETS IS AT OR BELOW $10,000 FOR A SINGLE PERSON AND $20,000 FOR A HOUSEHOLD OF TWO OR MORE. |
| PART I, LINE 7: | THE AMOUNTS IN PART I, LINE 7 WERE CALCULATED USING THE COST-TO-CHARGE RATIO PER WORKSHEET 2 OF THE IRS SCHEDULE H INSTRUCTIONS. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 437,955. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | ALLOWING LAKE VIEW EMPLOYEES TO PARTICIPATE IN VARIOUS COMMUNITY BUILDING ACTIVITIES NOT ONLY STRENGTHENS THE COMMUNITY AT LARGE BUT HEIGHTENS AWARENESS WITHIN THE COMMUNITY ABOUT THE HEALTHCARE SERVICES PROVIDED BY LAKE VIEW AND INCREASES LAKE VIEW'S AWARENESS OF COMMUNITY NEEDS. AS IT PERTAINS TO THE GENERAL HEALTH OF OUR COMMUNITIES SERVED THROUGH PARTICIPATION ON VARIOUS VOLUNTEER BOARDS AND INTERACTIONS WITH PUBLIC HEALTH AGENCIES, LAKE VIEW CAN PARTICIPATE IN SHAPING THE ECONOMIC GROWTH OF THE AREA AND COMMUNITIES SERVED. DEVELOPING AWARENESS AND STRONG STRATEGIC ALLIANCES IS VITAL TO THE SUCCESS NOT ONLY OF LAKE VIEW BUT OTHER BUSINESSES IN OUR SERVICE AREAS AS WELL. LAKE VIEW HOSPITAL CONTINUED TO COLLABORATE WITH VARIOUS COMMUNITY STAKEHOLDERS TO ADDRESS THE ONGOING, COMPLEX CHALLENGES OF PROVIDING CARE TO THE INCREASING NUMBER OF PATIENTS WITH MENTAL HEALTH ISSUES PRESENTING TO THE HOSPITAL EMERGENCY DEPARTMENT AND CLINIC. CITY AND COUNTY LAW ENFORCEMENT, EMS, COUNTY HUMAN SERVICES, COUNTY SOCIAL SERVICES, AND LOCAL GROUP HOME REPRESENTATIVES PARTICIPATED IN PROBLEM-SOLVING MEETINGS THAT CONTINUED THROUGHOUT THE YEAR. THE REHAB DEPARTMENT WAS INVOLVED IN THE COMMUNITY THROUGH OUTREACH PROGRAMS. THEY PARTICIPATED IN VARIOUS HEALTH FAIRS FOR LAKE COUNTY STAFF AND THE ANNUAL COMMUNITY PARTNERS SPRING CONFERENCE. THE STAFF PARTICIPATED IN VARIOUS EDUCATIONAL OUTREACH PROGRAMS AND ALSO HAD STUDENT INTERNS IN PT AND OT FROM LOCAL COLLEGES WITH REHAB STAFF PROVIDING ONE-ON-ONE MENTORING OF CLINICAL PATIENT SKILLS. ADDITIONALLY, A PHYSICAL THERAPIST TAUGHT STRENGTH & CONDITIONING CLASSES AT THE LOCAL HIGH SCHOOL TO INCREASE INTEREST IN PHYSICAL ACTIVITY AND PROMOTE HEALTH AND WELLNESS TO HIGH SCHOOL STUDENTS. LAKE VIEW WAS ALSO EXCITED TO CREATE A NEW POSITION OF EMPLOYEE AND COMMUNITY WELLNESS COORDINATOR, WHO FACILITATED COMMUNITY HEALTH EDUCATION EVENTS AND IS SUPPORTING THE CREATION OF A MORE COMPREHENSIVE EMPLOYEE WELLNESS PROGRAM. |
| PART III, LINE 2: | THE AMOUNT OF BAD DEBT EXPENSE REPORTED IN PART III, LINE 2 IS CALCULATED AS FOLLOWS: PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. |
| PART III, LINE 3: | LAKE VIEW HOSPITAL DOES NOT HAVE A METHOD TO CALCULATE WITH REASONABLY ACCURACY THE PORTION OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE BUT DID NOT COMPLETE AN APPLICATION. |
| PART III, LINE 4: | SEE THE "PATIENT RECEIVABLES" PARAGRAPH IN NOTE 1 ON PAGE 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | THE COST-TO-CHARGE RATIO WAS THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED ON THE MEDICARE COST REPORT.THE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE THE PEOPLE WHO RELY ON MEDICARE TEND TO BE LOWER INCOME AND MAY STRUGGLE TO ACCESS MEDICAL CARE IF THEY DIDN'T HAVE MEDICARE. LAKE VIEW HOSPITAL PROVIDES HEALTH CARE TO THESE INDIVIDUALS DESPITE THE LOSSES INCURRED THROUGH THE MEDICARE PROGRAM. |
| PART III, LINE 9B: | PRESUMPTIVE FINANCIAL ASSISTANCE ELIGIBILITY - THERE ARE INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR FINANCIAL DISCOUNTS, BUT THERE IS NO FINANCIAL ASSISTANCE FORM ON FILE OR A LACK OF SUPPORTING DOCUMENTATION. IN THE EVENT THERE IS NO EVIDENCE TO SUPPORT A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE, LAKE VIEW MAY USE OUTSIDE AGENCIES OR VENDORS IN DETERMINING ELIGIBILITY AND POTENTIAL DISCOUNT AMOUNTS. THESE RESOURCES MAY USE DEMOGRAPHIC AND HOUSEHOLD INFORMATION AND/OR CREDIT SCORING TECHNOLOGY TO DETERMINE THE PERCENT OF ASSISTANCE TO APPLY TO THE PATIENT'S ACCOUNT. PATIENTS WHO MEET PRESUMPTIVE ELIGIBILITY CRITERIA MAY BE GRANTED FINANCIAL ASSISTANCE WITHOUT COMPLETING THE APPLICATION. IF A PATIENT QUALIFIES FOR PRESUMPTIVE CHARITY AFTER ALL BILLING SERVICE COLLECTION EFFORTS HAVE FAILED, LAKE VIEW APPLIES THE PERCENTAGE OF FINANCIAL ASSISTANCE AND SENDS THE REMAINING BALANCE TO THE COLLECTION AGENCY. IF A PATIENT QUALIFIES FOR PRESUMPTIVE CHARITY BEFORE ALL COLLECTION EFFORTS HAVE FAILED, LAKE VIEW APPLIES THE PERCENTAGE OF FINANCIAL ASSISTANCE AND NOTIFIES THE BILLING SERVICE OF THE REDUCTION. THE BILLING SERVICE CONTINUES COLLECTION ACTIVITY ON THE ADJUSTED BALANCE. |
| PART VI, LINE 2: | IN ACCORDANCE WITH THE PATIENT PROTECTION AND AFFORDABLE CARE ACT, LAKE VIEW MEMORIAL HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT DURING 2019 TO ASSESS THE NEEDS OF THE COMMUNITY. THIS REPORT WILL COVER YEARS 2020 THROUGH 2022. |
| PART VI, LINE 3: | A REASONABLE EFFORT IS MADE TO ENSURE PATIENTS ARE AWARE OF ALL FINANCIAL ASSISTANCE OPPORTUNITIES, INCLUDING CITY, COUNTY, STATE, FEDERAL AND OTHER PRIVATE PROGRAMS. THE NOTICE OF FINANCIAL AID IS POSTED IN ALL MAJOR PATIENT REGISTRATION AREAS OF THE HOSPITAL AS WELL AS ON THE HOSPITAL'S WEBSITE. IN ADDITION, THE NOTICE IS AVAILABLE TO PATIENTS IN PRINTED FORM. TRAINING AND INFORMATION REGARDING FINANCIAL ASSISTANCE IS PROVIDED TO ALL MEMBERS OF THE STAFF THAT INTERACT WITH PATIENTS. AT A MINIMUM, THESE INDIVIDUALS ARE PREPARED TO REFER THE PATIENT TO HOSPITAL BUSINESS OFFICE STAFF OR SOCIAL WORKERS. |
| PART VI, LINE 4: | LAKE VIEW MEMORIAL HOSPITAL IS LOCATED IN THE CITY OF TWO HARBORS, LAKE COUNTY, MN, A RURAL COMMUNITY 25 MILES NORTHEAST OF DULUTH, MN, ON THE SHORES OF LAKE SUPERIOR. LAKE VIEW IS THE SOLE HEALTH CARE PROVIDER IN LAKE COUNTY, SERVING A POPULATION OF APPROXIMATELY 3,600 IN THE CITY OF TWO HARBORS, 1,400 IN THE CITY OF SILVER BAY, AND 11,000 TOTAL PEOPLE IN THE COMBINED PRIMARY AND SECONDARY SERVICE AREAS . THE MARKET AREA IS PROJECTED TO GROW BY APPROXIMATELY 3% FROM 2020 TO 2030. THE PRIMARY SERVICE AREA INCLUDES NINE COMMUNITIES: BEAVER BAY, BRIMSON, FINLAND, ISABELLA, KNIFE RIVER, SCHROEDER, SILVER BAY, TOFTE AND TWO HARBORS. THESE COMMUNITIES SUPPLY OVER 90% OF THE HOSPITAL'S INPATIENT AND SWING BED DISCHARGES. THE SECONDARY SERVICES AREA CONTAINS SIX COMMUNITIES, DEFINED BY ZIP CODE, FROM THE DULUTH AREA, AND ACCOUNT FOR 6% OF THE HOSPITAL'S INPATIENT AND SWING BED DISCHARGES. THE REMAINING 4% OF DISCHARGES COMES FROM COMMUNITIES OUTSIDE THESE SERVICE AREAS, LARGELY ATTRIBUTABLE TO TOURISM IN THE AREA. THE TWO HARBORS AREA OFFERS A WIDE ARRAY OF ACTIVITIES/ATTRACTIONS FOR TOURISTS AND RESIDENTS INCLUDING HIKING, FESTIVALS, CROSS-COUNTRY SKING, SNOWMOBILING, BIKING, CAMPING, FISHING, GOLF, BAND CONCERTS, BOATING, AND THE LAKE COUNTY FAIR. |
| PART VI, LINE 5: | LAKE VIEW MEMORIAL HOSPITAL IS THE ONLY HOSPITAL LOCATED IN LAKE COUNTY, MN. LAKE VIEW HAS A SIGNIFICANT IMPACT ON THE OVERALL HEALTH AND ACCESS TO MEDICAL SERVICES THROUGHOUT LAKE COUNTY BY PROVIDING A VARIETY OF HEALTH CARE SERVICES IN TWO HARBORS, SILVER BAY AND SURROUNDING AREAS. RESIDENTS CAN RECEIVE HIGH-QUALITY CARE IN THEIR OWN COMMUNITY WITHOUT HAVING TO DRIVE LONG DISTANCES TO LARGER CITIES. LAKE VIEW OFFERS COMPREHENSIVE SERVICES IN ITS MEDICAL CLINICS WITH PRIMARY AND SPECIALTY PHYSICIANS, RETAIL PHARMACY, HOME HEALTH SERVICES IN PARTNERSHIP WITH ST. LUKE'S HOSPITAL, COMPREHENSIVE REHAB SERVICES AND FITNESS CENTERS (PT, OT, SPEECH-LANGUAGE PATHOLOGY, CARDIAC REHAB), DIAGNOSTIC RADIOLOGY, SURGICAL AND PROCEDURAL SERVICES, FULL-SERVICE MEDICAL LAB, EMERGENCY ROOM AND URGENT CARE, AND A VARIETY OF INPATIENT SERVICES (OBSERVATION, ACUTE, SUB-ACUTE AND RESPITE PATIENTS). THE HOSPITAL PLAYS A VITAL ROLE IN THE INFRASTRUCTURE OF THE COUNTY AND IS ONE OF THE LARGEST EMPLOYERS IN TWO HARBORS WITH 148 EMPLOYEES. LAKE VIEW ALSO EMPLOYS MANY INDIVIDUALS WITH MODERATELY HIGH TO HIGH INCOMES. LAKE VIEW IS A SIGNIFICANT PURCHASER OF GOODS AND SERVICES IN TWO HARBORS AND SURROUNDING COMMUNITIES, AND THIS RESULTS IN A POSITIVE IMPACT ON THE LOCAL ECONOMIES. LAKE VIEW SUPPORTS MANY COMMUNITY ORGANIZATIONS THAT IMPACT THE OVERALL HEALTH OF THE COMMUNITY, INCLUDING BUT NOT LIMITED TO COMMUNITY PARTNERS, LAKE SUPERIOR SCHOOL DISTRICT, LAKE COUNTY AMBULANCE SERVICE, AND GOVERNMENTAL AGENCIES. ACCESS TO HIGH-QUALITY HEALTH CARE FACILITIES AND SCHOOLS IS VERY IMPORTANT IN ATTRACTING NEW BUSINESSES, RESIDENTS, AND FAMILIES TO COMMUNITIES. LAKE VIEW OFFERS THIS ACCESS TO COMPREHENSIVE FACILITIES AND PROVIDERS, AS WELL AS PROVIDING EMPLOYMENT OPPORTUNITIES TO NEW RESIDENTS. |
| PART VI, LINE 6: | LAKE VIEW MEMORIAL HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | MN |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KEVIN NOKELS TREASURER | ||||||||||||||
| ST. LUKE'S HOSP PRESIDENT/CEO | $0 | $635,922 | $0 | $0 | $0 | $26,000 | $0 | $4,275 | $0 | $167,678 | $0 | $833,875 | $0 | $0 |
| ERIC LOHN TREASURER | ||||||||||||||
| ST. LUKE'S HOSP CFO | $0 | $551,311 | $0 | $73,057 | $0 | $810 | $0 | $6,300 | $0 | $111,342 | $0 | $742,820 | $0 | $0 |
| NICHOLAS VAN DEELEN MD | ||||||||||||||
| ST. LUKE'S HOSP CMO | $0 | $380,986 | $0 | $0 | $0 | $4,439 | $0 | $8,212 | $0 | $103,927 | $0 | $497,564 | $0 | $0 |
| GREG RUBERG | ||||||||||||||
| PRESIDENT/CEO | $0 | $209,195 | $0 | $0 | $0 | $388 | $0 | $4,838 | $0 | $25,228 | $0 | $239,649 | $0 | $0 |
| ELIZABETH FEIST MD | ||||||||||||||
| PHYSICIAN | $139,894 | $0 | $0 | $0 | $29,532 | $0 | $224 | $0 | $26,929 | $0 | $196,579 | $0 | $0 | $0 |
| E TOLGA HANHAN MD | ||||||||||||||
| PHYSICIAN | $156,818 | $0 | $0 | $0 | $18,435 | $0 | $611 | $0 | $16,960 | $0 | $192,824 | $0 | $0 | $0 |
| KELSEY SCHULTZ MD | ||||||||||||||
| PHYSICIAN | $145,132 | $0 | $0 | $0 | $17,010 | $0 | $2,266 | $0 | $1,729 | $0 | $166,137 | $0 | $0 | $0 |
| LAURA HASE MD | ||||||||||||||
| PHYSICIAN | $120,537 | $0 | $0 | $0 | $18,968 | $0 | $1,120 | $0 | $23,100 | $0 | $163,725 | $0 | $0 | $0 |
| SHAWN MCMAHON MD | ||||||||||||||
| DIRECTOR & PHYSICIAN | $125,771 | $0 | $0 | $0 | $16,501 | $0 | $2,055 | $0 | $16,660 | $0 | $160,987 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | THE CEO OF LAKE VIEW MEMORIAL HOSPITAL IS AN EMPLOYEE OF ST. LUKE'S HOSPITAL OF DULUTH, A 501(C)(3) RELATED ORGANIZATION. THE FOLLOWING METHODS ARE USED BY ST. LUKE'S WHEN DETERMINING THE CEO'S COMPENSATION: 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. WRITTEN EMPLOYMENT CONTRACT 4. COMPENSATION SURVEY OR STUDY 5. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE |
| PART I, LINE 4B | ST. LUKE'S HOSPITAL OF DULUTH MAINTAINS 457(F) NONQUALIFIED DEFERRED COMPENSATION PLANS FOR ELIGIBLE EMPLOYEES. IN 2020, CONTRIBUTIONS TO THE 457(F) PLANS WERE: KEVIN NOKELS - $149,500 ERIC LOHN - $86,941 NICHOLAS VAN DEELEN, MD - $77,969 IN 2020, DISTRIBUTIONS FROM THE 457(F) PLAN WERE: ERIC LOHN - $73,057 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| CITY OF TWO HARBORS MN | |||||||
| A | 416005579 | 2003-08-25 | $6,000,000 | FUND HOSPITAL ADDITION, PURCHASE EQUIPMENT, AND REFINANCE SERIES 2002 BONDS | 0 | 0 | 0 |
| CITY OF TWO HARBORS MN | |||||||
| B | 416005579 | 2019-10-02 | $6,000,000 | FUND HOSPITAL ADDITION, & PURCHASE AGREEMENT. | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Other Spent ProceedsOtherSpentProceedsAmt | Substantial CompletionSubstantialCompletionYr | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | $3,406,110 | $6,000,000 | $120,000 | $1,696,358 | $4,183,642 | 2003 | Yes (1) | 0 | Yes (1) | Yes (1) |
| B | $6,000,000 | $107,400 | $919,212 | $4,973,388 | 2020 | 0 | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | Yes (1) | 0 | Yes (1) | 0 | 0 | 0 | 0 |
| B | 0 | 0 | Yes (1) | 0 | Yes (1) | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | Yes (1) |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE HOSPITAL HAS A MANAGEMENT SERVICES AGREEMENT WITH ST. LUKE'S HOSPITAL TO PROVIDE ADMINISTRATIVE, INFORMATION TECHNOLOGY, HUMAN RESOURCES, LAUNDRY, DIETICIAN, PHARMACY AND OTHER SERVICES. THE HOSPITAL PURCHASED APPROXIMATELY $1,922,000 IN SERVICES FROM ST. LUKE'S HOSPITAL FOR THE YEAR ENDED DECEMBER 31, 2020. |
| FORM 990, PART VI, SECTION A, LINE 6 | LAKE VIEW MEMORIAL HOSPITAL HAS A SINGLE CORPORATE MEMBER, ST. LUKE'S HOSPITAL OF DULUTH, A TAX-EXEMPT MINNESOTA NOT-FOR-PROFIT CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE HOSPITAL'S BOARD OF DIRECTORS NOMINATES POTENTIAL BOARD MEMBERS. HOWEVER, THE BOARD OF DIRECTORS OF ST. LUKE'S HOSPITAL OF DULUTH HAS THE AUTHORITY TO ELECT THE HOSPITAL'S BOARD MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7B | IN ADDITION TO DOING ALL THINGS REQUIRED BY LAW AND EXCEPT AS OTHERWISE PROVIDED, THE CORPORATE MEMBER SHALL HAVE THE FOLLOWING SPECIFIC RIGHTS AND RESPONSIBILITIES: A) APPOINT THE BOARD OF DIRECTORS; B) APPROVE ANY CHANGE IN THE PHILOSOPHY, CHARACTER OR MISSION, AND APPROVE THE LONG-RANGE GOALS, STRATEGIC PLANS AND OVERALL PURPOSES; C) APPROVE ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF LAKE VIEW MEMORIAL HOSPITAL AND ALL SUBSIDIARIES; D) APPROVE THE ADDITION OF NEW MEMBERS; E) APPROVE THE ESTABLISHMENT, TRANSFER AND/OR DISSOLUTION OF ANY SUBSIDIARY CORPORATION; F) APPROVE LONG-TERM BORROWING OF MONEY AND OTHER FORMS OF LONG-TERM INDEBTEDNESS; G) APPROVE THE PURCHASE, SALE, LEASE, DISPOSITION, ENCUMBRANCE OR ALIENATION OF REAL PROPERTY, AND THE SALE, LEASE, DISPOSITION OR ENCUMBRANCE OF SUBSTANTIALLY ALL OF THE PERSONAL PROPERTY; H) PARTICIPATE IN THE PREPARATION OF, AND GIVE APPROVAL TO, ANY PLAN OF DISSOLUTION OR MERGER, CONSOLIDATION, ACQUISITION OR DISPOSITION OF REAL PROPERTY OR RELOCATION OF THE FACILITIES; I) RATIFY THE CHIEF EXECUTIVE OFFICER AS RECOMMENDED BY THE BOARD OF DIRECTORS; J) APPROVE ANY RECOMMENDATION BY THE BOARD OF DIRECTORS TO REMOVE THE CHIEF EXECUTIVE OFFICER AND CONDUCT REGULAR EVALUATION OF THE CHIEF EXECUTIVE OFFICER IN CONJUNCTION WITH THE BOARD OF DIRECTORS; K) CONDUCT, THROUGH THE CORPORATE MEMBER'S CEO, REGULAR EVALUATIONS OF THE CHIEF EXECUTIVE OFFICER OF THE HOSPITAL IN CONJUNCTION WITH THE BOARD OF DIRECTORS; L) RATIFY THE BUDGETS AND APPROVE UNBUDGETED CAPITAL EXPENDITURES GREATER THAN $100,000 IN ANY ONE FISCAL YEAR; M) REVIEW AND APPROVE THE AUDITED FINANCIAL REPORTS; N) RATIFY THE SELECTION AND RETENTION OF THE INDEPENDENT AUDITING FIRM AND LEGAL COUNSEL; AND O) HAVE THE EXCLUSIVE AUTHORITY TO APPROVE ALL USE BY THE CORPORATION OF THE NAME "ST LUKES HOSPITAL AND ANY OTHER TRADE NAMES OR REFERENCES TO ST LUKES. |
| FORM 990, PART VI, SECTION B, LINE 11B | MANAGEMENT REFERENCED MULTIPLE SOURCES OF INFORMATION IN ORDER TO ACCURATELY PREPARE THE 2020 FORM 990. THE SOURCES OF INFORMATION INCLUDE THE INTERNAL REVENUE SERVICE WEBSITE, HEALTHCARE TRADE ASSOCIATIONS AND OTHER VARIOUS PUBLICATIONS. A FINAL DRAFT OF THE FORM WAS PREPARED AND REVIEWED BY THE FOLLOWING GROUPS: 1) LAKE VIEW'S OFFICERS AND SENIOR MANAGEMENT; 2) LAKE VIEW'S BOARD OF DIRECTORS. IN THE CASE OF THE BOARD OF DIRECTORS, THE FINAL DRAFT FORM 990 REVIEW WAS LISTED AS AN AGENDA ITEM AT THEIR OCTOBER 2021 MEETING. BOARD MEMBERS WERE ASKED TO REVIEW THE DOCUMENT AND DIRECT ANY QUESTIONS TO THE CHIEF FINANCIAL OFFICER. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH DIRECTOR, OFFICER AND COMMITTEE MEMBER SHALL SIGN, AS A CONDITION TO SERVING THE CORPORATION IN HIS/HER RESPECTIVE ROLE AND ANNUALLY THEREAFTER, A STATEMENT AGREEING TO BE BOUND BY THE TERMS OF THE POLICY. PURSUANT TO THE POLICY, ANY DIRECTOR, OFFICER OR COMMITTEE MEMBER HAVING A FINANCIAL INTEREST IN A CONTRACT OR OTHER TRANSACTION PRESENTED TO THE BOARD OF DIRECTORS OR A COMMITTEE THEREOF FOR AUTHORIZATION, APPROVAL, OR RATIFICATION SHALL MAKE A PROMPT, FULL AND FRANK DISCLOSURE OF SUCH PERSON'S INTEREST TO THE BOARD OR COMMITTEE PRIOR TO ITS ACTING ON SUCH CONTRACT OR TRANSACTION. SUCH DISCLOSURE SHALL INCLUDE ANY RELEVANT AND MATERIAL FACTS, KNOWN TO SUCH PERSON, ABOUT THE CONTRACT OR TRANSACTION WHICH MIGHT REASONABLY BE CONSTRUED TO BE ADVERSE TO THE CORPORATION'S INTEREST. THE BOARD OR COMMITTEE TO WHICH SUCH DISCLOSURE IS MADE SHALL THEREUPON DETERMINE, BY MAJORITY VOTE, WHETHER THE DISCLOSURE SHOWS THAT A CONFLICT OF INTEREST EXISTS OR CAN REASONABLY BE CONSTRUED TO EXIST. IF A CONFLICT IS DEEMED TO EXIST, SUCH PERSON SHALL NOT VOTE ON, NOR USE PERSONAL INFLUENCE ON, OR PARTICIPATE (OTHER THAN TO PRESENT FACTUAL INFORMATION TO OR RESPOND TO QUESTIONS) IN THE DISCUSSIONS AND DELIBERATIONS WITH RESPECT TO SUCH CONTRACT OR TRANSACTION. SUCH PERSON MAY BE COUNTED IN DETERMINING THE EXISTENCE OF A QUORUM AT ANY MEETING WHERE THE CONTRACT OR TRANSACTION IS UNDER DISCUSSION OR IS BEING VOTED UPON. THE MINUTES OF THE MEETING SHALL REFLECT THE DISCLOSURE MADE, THE VOTE AND, WHERE APPLICABLE, THE ABSTENTION FROM VOTING AND PARTICIPATION, AND WHETHER A QUORUM WAS PRESENT. |
| FORM 990, PART VI, SECTION B, LINE 15 | CEO COMPENSATION IS HANDLED BY ST. LUKE'S HOSPITAL, AS LAKE VIEW PRESIDENT/CEO IS AN EMPLOYEE OF ST. LUKE'S HOSPITAL AND IS CONTRACTED TO BACK TO LAKE VIEW MEMORIAL HOSPITAL VIA THE INTER-COMPANY MASTER SERVICES AGREEMENT. ST. LUKE'S USES A COMBINATION OF INDEPENDENT REVIEW, EXECUTIVE SALARY SURVEYS AND OTHER METHODS WHEN DETERMINING THE CEO'S COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | LAKE VIEW MEMORIAL HOSPITAL'S GOVERNING DOCUMENTS AND CONFLICTS OF INTEREST STATEMENTS ARE REVIEWED AND UPDATED ANNUALLY BY THE BOARD OF DIRECTORS. THEY ARE NOT AVAILABLE TO THE GENERAL PUBLIC. THE FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC AS AN ATTACHMENT TO THE FORM 990. |
| FORM 990, PART IX, LINE 11G | OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 3,250,555. MANAGEMENT AND GENERAL EXPENSES 662,749. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,913,304. |
| FORM 990, PART XI, LINE 9: | CHANGE IN INVESTMENT IN LAKEVIEW FOUNDATION 127,631. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| LAKE VIEW MEMORIAL HOSPITAL FOUNDATION OF NORTHEAST MINNESOTA | |||||||||||
| 325 11TH AVENUE | TWO HARBORS | MN | 55616 | 411700972 | FUNDRAISING SUPPORT FOR LAKE VIEW MEMORIAL HOSPITAL | MN | 501(C)(3) | LINE 12A, I | LAKE VIEW MEMORIAL HOSPITAL | Yes (1) | |
| ST LUKE'S HOSPITAL OF DULUTH | |||||||||||
| 915 E 1ST STREET | DULUTH | MN | 55805 | 410714079 | HEALTH CARE / HOSPITAL | MN | 501(C)(3) | LINE 3 | 0 | N/A | |
| ST LUKE'S FOUNDATION | |||||||||||
| 1000 E 1ST STREET SUITE 120 | DULUTH | MN | 55805 | 411448118 | FUNDRAISING SUPPORT FOR ST. LUKE'S HOSPITAL OF DULUTH | MN | 501(C)(3) | LINE 12A, I | ST LUKE'S HOSPITAL OF DULUTH | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | 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 | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |