ELY-BLOOMENSON COMMUNITY HOSPITAL: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- ELY-BLOOMENSON COMMUNITY HOSPITAL (EIN 41-0808719)
- Tax period
- 2023-10-01 to 2024-09-30
- Filed
- 2025-08-14
- IRS object ID
- 202542269349301434
- Schema version
- 2023v6.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-08-14T12:53:18-05:00 | ReturnTs |
| Tax Period End | 2024-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 420714325 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RSM US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 227 WEST FIRST STREET SUITE 700 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55802 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410808719 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ELY-BLOOMENSON COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ELY- | BusinessNameControlTxt |
| Phone | 2183653271 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 328 WEST CONAN STREET | AddressLine1Txt |
| City | ELY | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55731 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TIMOTHY BALTHAZOR | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 2183653271 | PhoneNum |
| Signature | 2025-08-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JULIE BOYER | PreparerPersonNm |
| PTIN | P01278549 | PTIN |
| Phone | 2187275025 | PhoneNum |
| Preparation | 2025-08-13 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PATTI BANKS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 328 WEST CONAN STREET | AddressLine1Txt |
| City | ELY | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55731 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $34,733,877 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.EBCH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1956 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | ELY-BLOOMENSON COMMUNITY HOSPITAL IS COMMITTED TO CARING FOR AND ENHANCING THE HEALTH AND WELL BEING OF THE COMMUNITY IT SERVES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 151 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $4,516,241 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $903,426 | PYContributionsGrantsAmt |
| CY Contributions Grants | $565,000 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $29,907,971 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $32,569,536 | CYProgramServiceRevenueAmt |
| PY Investment Income | $293,528 | PYInvestmentIncomeAmt |
| CY Investment Income | $392,472 | CYInvestmentIncomeAmt |
| PY Other Revenue | $90,606 | PYOtherRevenueAmt |
| CY Other Revenue | $77,466 | CYOtherRevenueAmt |
| PY Total Revenue | $31,195,531 | PYTotalRevenueAmt |
| CY Total Revenue | $33,604,474 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $85,119 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $110,579 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,959,980 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,828,592 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $18,423,113 | PYOtherExpensesAmt |
| CY Other Expenses | $19,225,515 | CYOtherExpensesAmt |
| PY Total Expenses | $30,468,212 | PYTotalExpensesAmt |
| CY Total Expenses | $33,164,686 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $727,319 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $439,788 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $29,881,505 | TotalAssetsBOYAmt |
| Total Assets EOY | $29,624,244 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $12,463,218 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,984,652 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $17,418,287 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $18,639,592 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | ELY-BLOOMENSON COMMUNITY HOSPITAL IS COMMITTED TO CARING FOR AND ENHANCING THE HEALTH AND WELL-BEING OF THE COMMUNITY IT SERVES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $28,085,702 | ExpenseAmt |
| Grant | $110,579 | GrantAmt |
| Revenue | $32,622,535 | RevenueAmt |
| Desc | HOSPITAL SERVICES PROVIDED FOR THE ELY COMMUNITY AND SURROUNDING AREA. ELY-BLOOMENSON COMMUNITY HOSPITAL (EBCH), RECOGNIZED BY THE FEDERAL & STATE OF MINNESOTA GOVERNMENTS AS A CRITICAL ACCESS HOSPITAL, IS THE ONLY LOCAL HEALTHCARE CENTER SERVING ELY AND SURROUNDING COMMUNITIES BORDERING THE VAST ACREAGE OF BOUNDARY WATERS CANOE AREA WILDERNESS. UNDER ORIGINAL FEDERAL RULES EBCH WOULD HAVE BEEN ONLY ONE OUT OF SEVEN HOSPITALS IN MINNESOTA THAT WOULD HAVE QUALIFIED FOR CRITICAL ACCESS HOSPITAL STATUS. THE HOSPITAL BOASTS: IN AND OUTPATIENT HOSPITAL NURSING SERVICE, IN-HOUSE LABORATORY, AN ON-SITE RETAIL PHARMACY, PHYSICAL AND OCCUPATIONAL THERAPY, CHEMOTHERAPY, A FULLY-STAFFED 24-7 RADIOLOGY DEPARTMENT, A PROFESSIONAL ANESTHESIA TEAM, SWING BED CARE FOR PATIENTS WHO NO LONGER REQUIRE ACUTE CARE HOSPITALIZATION, AND A 24-7 EMERGENCY ROOM. DURING THE FY2024 EBCH PERFORMED 629 SURGICAL PROCEDURES, 27,460 LABORATORY TESTS, 7,233 RADIOLOGICAL EXAMS, AND 3,776 EMERGENCY ROOM VISITS. IN ADDITION, 224 PEOPLE WERE ADMITTED FOR INPATIENT CARE. 578 DAYS OF CARE WERE PROVIDED FOR INPATIENTS AND 398 DAYS OF CARE WERE PROVIDED TO SWING BED PATIENTS, 3,036 OUTPATIENTS WERE SEEN, 20,206 MODALITIES WERE PERFORMED IN OT AND PT, AND 1,241 MODALITIES WERE PERFORMED IN CARDIAC REHAB. | Desc |
| Total Program Service Expenses | $28,085,702 | 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 | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 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 | Yes (1) | 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 43 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 151 | 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 | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 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 | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedureInd |
| 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 | PATTI BANKS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2183653271 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 328 WEST CONAN STREET | AddressLine1Txt |
| City | ELY | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55731 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| RIANA HEGMAN | |||||||||
| DIRECTOR | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| STEPHEN PETERSON SR | |||||||||
| DIRECTOR | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| JOHN SAW | |||||||||
| DIRECTOR | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| MARY ANN SMITH | |||||||||
| DIRECTOR | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| ROBERT WILMUNEN | |||||||||
| DIRECTOR | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| JO LANGAN | |||||||||
| DIRECTOR UNTIL 12/31/23 | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| TODD HEIMAN | |||||||||
| TREASURER | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| KELLY KLUN | |||||||||
| SECRETARY UNTIL 12/31/23 | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| BARBARA SODERBERG | |||||||||
| SECRETARY | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| TIM RILEY | |||||||||
| VICE PRESIDENT | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| DEVON LUTHENS | |||||||||
| PRESIDENT | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| PATTI BANKS | |||||||||
| CEO | 39.50 | 0.50 | $248,682 | $0 | $43,202 | Yes (X) | |||
| BROCK URIE | |||||||||
| CMO/PHYSICIAN | 40.00 | 0.00 | $418,927 | $0 | $0 | Yes (X) | |||
| SAM RICE | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $195,241 | $0 | $32,641 | Yes (X) | |||
| KARLA GRIZZARD | |||||||||
| RN | 40.00 | 0.00 | $182,753 | $0 | $37,293 | Yes (X) | |||
| JOHN SCHINDELE | |||||||||
| PHARMACIST | 40.00 | 0.00 | $176,080 | $0 | $43,567 | Yes (X) | |||
| BETH HARTSHORN | |||||||||
| PHARMACIST | 40.00 | 0.00 | $160,086 | $0 | $16,486 | Yes (X) | |||
| ABIGAIL SIREK | |||||||||
| PHARMACIST | 40.00 | 0.00 | $150,399 | $0 | $15,992 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,532,168 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $189,181 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 20 | 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 |
|---|---|---|---|---|---|
| CENTRAL MINNESOTA DIAGNOSTIC INC | |||||
| PO BOX 158 | MILACA | MN | 56353 | DIAGNOSTIC EQUIP SERVICE | $1,082,970 |
| ACUTE CARE INC | |||||
| 1609 N ANKENY BLVD STE 200 | ANKENY | IA | 50023 | EMERGENCY ROOM PHYSICIAN COVERAGE | $981,982 |
| LAKE COUNTRY ANESTHESIA LLC | |||||
| 2760 BEAR ISLAND RIVER RD | ELY | MN | 55731 | ANESTHESIA SERVICES | $955,935 |
| RSM US LLP | |||||
| 5155 PAYSPHERE CIRCLE | CHICAGO | IL | 60674 | ACCOUNTING, AUDITING & CONSULTING SERVIC | $774,870 |
| ESSENTIA HEALTH SHARED SERVICES | |||||
| 502 EAST 2ND ST | DULUTH | MN | 55805 | EPIC SOFTWARE SERVICES | $443,291 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 15 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $425,000 | RelatedOrganizationsAmt |
| Government Grants | $125,000 | GovernmentGrantsAmt |
| All Other Contributions | $15,000 | AllOtherContributionsAmt |
| Total Contributions | $565,000 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENT SERVICE | 621400 | $27,606,327 | $27,606,327 | |
| RETAIL PHARMACY | 456110 | $4,516,241 | $4,516,241 | |
| EQUITY IN EARNINGS OF AFFILIATES | 900099 | $446,968 | $446,968 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $32,569,536 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $508,202 | TotalRevenueColumnAmt |
| Exclusion | $508,202 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $26,448 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,981 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $24,467 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,467 | TotalRevenueColumnAmt |
| Exclusion | $24,467 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,011,692 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,127,422 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$115,730 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$115,730 | TotalRevenueColumnAmt |
| Exclusion | -$115,730 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER OPERATING | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $52,999 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $52,999 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $52,999 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $33,604,474 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $28,106,294 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $4,516,241 | UnrelatedBusinessRevenueAmt |
| Exclusion | $416,939 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $110,579 | TotalAmt |
| Program Services | $110,579 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $796,529 | TotalAmt |
| Program Services | $450,537 | ProgramServicesAmt |
| Management And General | $345,992 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,574,090 | TotalAmt |
| Program Services | $8,426,166 | ProgramServicesAmt |
| Management And General | $1,147,924 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $318,487 | TotalAmt |
| Program Services | $293,303 | ProgramServicesAmt |
| Management And General | $25,184 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,416,896 | TotalAmt |
| Program Services | $2,297,359 | ProgramServicesAmt |
| Management And General | $119,537 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $722,590 | TotalAmt |
| Program Services | $624,759 | ProgramServicesAmt |
| Management And General | $97,831 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,653 | TotalAmt |
| Management And General | $48,653 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $455,423 | TotalAmt |
| Management And General | $455,423 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,210 | TotalAmt |
| Management And General | $2,210 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,202,245 | TotalAmt |
| Program Services | $4,159,541 | ProgramServicesAmt |
| Management And General | $1,042,704 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,885 | TotalAmt |
| Program Services | $67,656 | ProgramServicesAmt |
| Management And General | $71,229 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $232,813 | TotalAmt |
| Program Services | $165,875 | ProgramServicesAmt |
| Management And General | $66,938 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $867,831 | TotalAmt |
| Program Services | $490,552 | ProgramServicesAmt |
| Management And General | $377,279 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $231,193 | TotalAmt |
| Program Services | $231,193 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,043 | TotalAmt |
| Program Services | $27,763 | ProgramServicesAmt |
| Management And General | $61,280 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $221,557 | TotalAmt |
| Management And General | $221,557 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,021,397 | TotalAmt |
| Program Services | $935,711 | ProgramServicesAmt |
| Management And General | $85,686 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,313 | TotalAmt |
| Management And General | $138,313 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| DRUGS | $5,715,291 | $5,715,291 | |
| LEASE EXPENSE | $1,358,133 | $1,358,133 | |
| MEDICAL SUPPLIES | $1,150,524 | $1,045,722 | $104,802 |
| REPAIRS & MAINTENANCE | $683,882 | $669,986 | $13,896 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,668,122 | TotalAmt |
| Program Services | $1,015,576 | ProgramServicesAmt |
| Management And General | $652,546 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,164,686 | TotalAmt |
| Program Services | $28,085,702 | ProgramServicesAmt |
| Management And General | $5,078,984 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,010,223 | BOYAmt |
| EOY | $1,968,818 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,047,226 | BOYAmt |
| EOY | $3,678,683 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $250,000 | BOYAmt |
| EOY | $62,500 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,136,806 | BOYAmt |
| EOY | $1,000,945 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $272,281 | BOYAmt |
| EOY | $362,145 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $27,836,119 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $21,972,027 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,937,487 | BOYAmt |
| EOY | $5,864,092 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,702,135 | BOYAmt |
| EOY | $11,246,064 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,525,347 | BOYAmt |
| EOY | $5,440,997 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,881,505 | BOYAmt |
| EOY | $29,624,244 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,305,258 | BOYAmt |
| EOY | $1,979,898 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $109,154 | BOYAmt |
| EOY | $68,221 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,235,667 | BOYAmt |
| EOY | $5,486,575 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,528 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,808,611 | BOYAmt |
| EOY | $3,449,958 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,463,218 | BOYAmt |
| EOY | $10,984,652 | 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 | $17,418,287 | BOYAmt |
| EOY | $18,639,592 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,418,287 | BOYAmt |
| EOY | $18,639,592 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,881,505 | BOYAmt |
| EOY | $29,624,244 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $439,788 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $804,517 | NetUnrlzdGainsLossesInvstAmt |
| Donated Services And Use Fclts | -$23,000 | DonatedServicesAndUseFcltsAmt |
| 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) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| 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 | $2,210 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,210 | 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 HOSPITAL PAYS DUES TO CERTAIN ORGANIZATIONS RELATED TO THE INDUSTRY WHICH HAVE LOBBYING EXPENSES. THE AMOUNT LISTED IS THE PERCENTAGE OF THE DUES PAID THAT WERE USED FOR LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $77,500 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $56 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $56 | AdministrativeExpensesAmt |
| End Year Balance | $77,500 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $77,500 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $9 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $9 | AdministrativeExpensesAmt |
| End Year Balance | $77,500 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $77,500 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $2 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $2 | AdministrativeExpensesAmt |
| End Year Balance | $77,500 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $77,500 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $462 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $462 | AdministrativeExpensesAmt |
| End Year Balance | $77,500 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $77,500 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,594 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $1,594 | AdministrativeExpensesAmt |
| End Year Balance | $77,500 | 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 | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $76,827 | InvestmentCostOrOtherBasisAmt |
| Book Value | $76,827 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $16,176,821 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $14,099,652 | DepreciationAmt |
| Book Value | $2,077,169 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $9,336,454 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $6,474,879 | DepreciationAmt |
| Book Value | $2,861,575 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $2,246,017 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $1,397,496 | DepreciationAmt |
| Book Value | $848,521 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,864,092 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (6 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INTEREST RECEIVABLE | $29 |
| DIRECT FINANCING LEASE | $961,819 |
| INVESTMENT IN AFFILIATES | $1,098,926 |
| OPERATING RIGHT-OF-USE LEASE ASSETS | $2,382,658 |
| FINANCE RIGHT-OF-USE LEASE ASSETS | $752,300 |
| THIRD-PARTY PAYOR SETTLEMENTS | $245,265 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $5,440,997 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| OPERATING RIGHT-OF-USE LEASE LIABILITIES | $2,382,658 |
| THIRD-PARTY PAYOR SETTLEMENTS | $315,000 |
| FINANCE RIGHT-OF-USE LEASE LIABILITIES | $752,300 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,449,958 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $33,588,114 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $804,517 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$820,877 | OtherRevenueAmt |
| Revenue Not Reported | -$16,360 | RevenueNotReportedAmt |
| Revenue Subtotal | $33,604,474 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $33,604,474 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $32,366,809 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $23,000 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $23,000 | ExpensesNotReportedAmt |
| Expenses Subtotal | $32,343,809 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $820,877 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $820,877 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $33,164,686 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE ENDOWMENT FUNDS ARE HELD BY ELY HEALTH AND HOSPITAL FOUNDATION. THE INCOME FROM THE ENDOWMENT FUNDS WILL BE USED FOR GRANTS AND CONTRIBUTIONS. |
| PART X, LINE 2: | THE HOSPITAL IS A NONPROFIT HOSPITAL AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES. THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ISSUED GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. MANAGEMENT EVALUATED THE HOSPITAL'S TAX POSITIONS AND CONCLUDED THE HOSPITAL HAS TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF THE GUIDANCE. GENERALLY, THE HOSPITAL IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE OR LOCAL TAX AUTHORITIES FOR YEARS BEFORE 2021. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | IMPLICIT PRICE CONCESSIONS -633,377. EXPENSE NETTED WITH REVENUE -187,500. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | IMPLICIT PRICE CONCESSIONS 633,377. EXPENSE NETTED WITH REVENUE 187,500. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 125.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 180.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $339,690 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $339,690 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01040 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,360,243 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,215,698 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,144,545 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03520 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,699,933 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,215,698 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,484,235 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04560 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $103,398 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $103,398 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00320 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $149,462 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $149,462 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00460 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $244,894 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $244,894 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00750 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $497,754 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $497,754 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01530 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,197,687 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,215,698 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,981,989 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06090 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,540 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $15,540 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,540 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $15,540 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $633,377 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $8,832,189 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,705,671 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $126,518 | 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 | ELY-BLOOMENSON COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 328 WEST CONAN STREET | AddressLine1Txt |
| City | ELY | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55731 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| State License | 410419 | 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 | N/A | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ELY-BLOOMENSON COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, PAGE 8 | 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 | SEE PART V, PAGE 8 | 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 | 125.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 180.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| 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, PAGE 8 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, PAGE 8 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, PAGE 8 | 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 |
| 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 (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ELY-BLOOMENSON COMMUNITY HOSPITAL | PART V, SECTION B, LINE 5: EBCH PROVIDED RHI WITH A COUNT OF INPATIENT ADMISSIONS BY ZIP CODE FROM THE PREVIOUS YEAR. ZIP CODES WITH THE GREATEST NUMBER OF ADMISSIONS AND UTILIZATION WERE STRATIFIED IN THE INITIAL SAMPLE SELECTION. EACH AREA WOULD BE REPRESENTED IN THE SAMPLING PROPORTIONATELY TO BOTH THE OVERALL SERVED POPULATION AND THE NUMBER OF PAST ADMISSIONS OR UTILIZATION. EIGHT HUNDRED ADDRESSES REPRESENTING THE SAMPLE AREA WERE SELECTED RANDOMLY FROM PRIMENET DATA SOURCE, A MARKETING ORGANIZATION. ALTHOUGH THE SURVEY SAMPLES WERE PROPORTIONATELY SELECTED, ACTUAL SURVEYS RETURNED FROM EACH POPULATION AREA VARIED. THIS MAY RESULT IN SLIGHTLY LESS PROPORTIONAL RESULTS. THE CHNA, A COVER LETTER ON EBCH'S LETTERHEAD, AND A POSTAGE PAID REPLY ENVELOPE WERE MAILED FIRST CLASS TO 800 RANDOMLY SELECTED RESIDENTS IN THE TARGETED REGION (SEVEN ZIP CODES). EBCH ANNOUNCED THE CHNA SURVEY IN A PRESS RELEASE IN THE ELY ECHO AND THE TIMBERJAY NEWSPAPERS THE WEEK OF OCTOBER 25, 2021. THE INFORMATION RAN IN THE TIMBERJAY ON OCTOBER 29, 2021, AND THE ELY ECHO ON OCTOBER 30, 2021. EBCH ALSO PROMOTED THE SURVEY ON SOCIAL MEDIA AND THE LOCAL RADIO STATION WELY. |
| ELY-BLOOMENSON COMMUNITY HOSPITAL | PART V, SECTION B, LINE 11: THE HOSPITAL IDENTIFIED THE FOLLOWING SIGNIFICANT NEEDS IN ITS MOST RECENTLY CONDUCTED CHNA: 1. ACCESS TO DENTAL SERVICES2. ACCESS TO CHILDCARE3. ACCESS TO SPECIALISTS4. DENTAL CARE5. AVAILABILITY OF SERVICES/ PROVIDERS6. MENTAL HEALTH SERVICESELY-BLOOMENSON COMMUNITY HOSPITAL (EBCH) AND ITS BOARD OF DIRECTORS IDENTIFIED THE FOLLOWING THREE SIGNIFICANT NEEDS. THE HOSPITAL IS ADDRESSING ALL OF THE SIGNIFICANT NEEDS IN SOME CAPACITY: 1.) INCREASE IN ACCESS TO SPECIALTY SERVICES2.) INCREASE IN COMMUNITY AWARENESS AND EDUCATION3.) INCREASE IN ACCESS TO CHILDCARESOME OF THE ONGOING COMMUNITY BENEFIT ACTIVITIES THAT EBCH IS PARTICIPATING IN FOR EACH OF THE SIGNIFICANT NEEDS INCLUDE: 1. WE CONTINUE TO WORK WITH OTHER HEALTHCARE PARTNERS TO INCREASE THE AVAILABILITY OF SERVICES AND PROVIDERS AT EBCH. EBCH HAS THE FOLLOWING SPECIALTIES: PODIATRY, ORTHOPEDICS, GENERAL SURGERY AND GASTROENTEROLOGY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, INFUSIONS, AND CARDIAC REHAB. CURRENTLY EBCH IS EXPLORING ADDING ADDITIONAL SPECIALTIES WITH LIMITED FINANCIAL RESOURCES. EBCH PARTNERS WITH LOCAL DENTAL OFFICES AND THE FREE CLINIC TO ADDRESS NEEDS WHEN APPROPRIATE.2. INCREASE IN ACCESS TO SPECIALTY SERVICES WAS IDENTIFIED BY THE BOARD OF DIRECTORS AND THE CHNA AS A SIGNIFICANT NEED. WE PROVIDE ONGOING PRINT AND RADIO ADS ADVERTISING THESE SPECIALTY SERVICES AND WHAT THEY CAN DO FOR THE COMMUNITY. EBCH HAS INCREASED ITS SOCIAL MEDIA PRESENCE REGARDING HEALTH TOPICS WITHIN THE COMMUNITY THROUGH ITS PARTNERSHIP WITH VARIOUS MARKETING COMPANY'S. EBCH ALSO CREATED MARKETING MATERIALS TO GIVE TO LARGE EMPLOYERS IN THE AREA. EBCH ALSO HAS EMPLOYEESSPEAK AT LOCAL MEETINS OF CIVIC GROUPS.3. THE CEO, PATTI BANKS, DURING TAX YEAR 2021, JOINED THE BOARD OF THE ELY AREA COMMUNITY FOUNDATION THAT IS WORKING ON A PROJECT TO PROVIDE AN AFFORDABLE BUILDING SPACE FOR A LOCAL DAY CARE FACILITY. THIS BUILDING IS ALSO HOME TO OTHER HEALTH AND WELNESS ORGANIZATIONS. EBCH CONTINUES TO EVALUATE AND DETERMINE THE BEST WAY TO PROVIDE CHILDCARE SERVICES TO THE COMMUNITY WITH LIMITED FINANCIAL RESOURCES.4. THE CHNA NOTES THAT THERE IS A GAP IN MENTAL HEALTH CARE SERVICES; WE CONTINUE TO PARTNER WITH MANY LOCAL ORGANIZATIONS SUCH AS BEHAVIORAL HEALTH NETWORK AND EPARC TO BRING AWARENESS TO MENTAL HEALTH AND ASSOCIATED SUBSTANCE ABUSE. EBCH IS ALSO PARTICIPATING IN THE MN PATH TO VALUES AND IS PART OF THE MENTAL HEALTH COMMUNITY CARE TEAM. EBCH IS DETERMINING THE BEST WAY TO PROVIDE MENTAL HEALTH SERVICES TO THE COMMUNITY WITH LIMITED FINANCIAL RESOURCES. EBCH IS ALSO CONSIDERING UTILIZING TELEHEALTH WHEN APPLICABLE.5. THE CHNA NOTES THAT ACCESS TO DENTAL SERVICES IS A SIGNIFICANT NEED IN THE COMMUNITY, EBCH DONATES TO THE ELY FREE CLINIC WHICH PROVIDES DENTAL SERVICES. EBCH IS DETERMINING THE BEST WAY TO PROVIDE DENTAL SERVICES TO THE COMMUNITY WITH LIMITED FINANCIAL RESOURCES. |
| PART V, LINE 7A, CHNA - HOSPITAL'S WEBSITE | HTTPS://WWW.EBCH.ORG/COMMUNITY-HEALTH/COMMUNITY-HEALTH-NEEDS-ASSESSMENT |
| PART V, LINE 10, IMPLEMENTATION PLAN WEBSITE | HTTPS://WWW.EBCH.ORG/COMMUNITY-HEALTH/COMMUNITY-HEALTH-NEEDS-ASSESSMENT |
| PART V, LINE 16A, FAP WEBSITE | HTTPS://WWW.EBCH.ORG/WP-CONTENT/UPLOADS/2025/03/EBCH-FINANCIAL-ASSISTANCE-POLICY-2025-1.PDF |
| PART V, LINE 16B, FAP APPLICATION WEBSITE | HTTPS://WWW.EBCH.ORG/WP-CONTENT/UPLOADS/2025/03/EBCH-FINANCIAL-ASSISTANCE-APPLICATION-2025.PDF |
| PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY: | HTTPS://WWW.EBCH.ORG/WP-CONTENT/UPLOADS/2025/03/EBCH-FAP-PLAIN-LANGUAGE-SUMMARY-2025.PDF |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO FROM THE AS FILED 9/30/2024 MEDICARE COST REPORT. |
| PART I, LN 7 COL(F): | IMPLICIT PRICE CONCESSIONS FROM THE FINANCIAL STATEMENTS IS $633,377. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | COMMUNITY SUPPORT: COMMUNITY BUILDING ACTIVITIES PROMOTED HEALTH IN THE COMMUNITY BY ALLOWING THE COMMUNITY TO USE CONFERENCE ROOM SPACE FREE OF CHARGE TO DISCUSS AND PREPARE FOR HEALTH ISSUES OR EMERGENCIES. MOST OF THESE MEETINGS ARE TIED TO EMERGENCY PREPAREDNESS AND EMERGENCY MANAGEMENT. THERE WAS ALSO IP SPECIFIC EDUCATION, UNDER ONE ROOF CONFERENCE, MASS CASUALTY DRILL & DECONTAMINATION EQUIPMENT REVIEW. |
| PART III, LINE 2: | THE HOSPITAL DETERMINES THIS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH CERTAIN CLASSES OF PATIENTS USING A PORTFOLIO APPROACH AS A PRACTICAL EXPEDIENT TO ACCOUNT FOR PATIENT CONTRACT AS COLLECTIVE GROUPS RATHER THAN INDIVIDUALLY. |
| PART III, LINE 4: | FROM FOOTNOTE 1 OF THE AUDITED FINANCIAL STATEMENTS: WHEN THERE IS AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME, THE RIGHT IS TREATED AS A RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS FOR WHICH THE HOSPITAL HAS THE UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYORS FOR RETROACTIVE ADJUSTMENTS ARE RECEIVABLES IF THE HOSPITALS RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. FOR PATIENT ACCOUNTS RECEIVABLE, THE ESTIMATED UNCOLLECTIBLE AMOUNTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO PATIENT ACCOUNTS RECEIVABLE RATHER THAN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE HOSPITAL DETERMINES THIS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH CERTAIN CLASSES OF PATIENTS USING A PORTFOLIO APPROACH AS A PRACTICAL EXPEDIENT TO ACCOUNT FOR PATIENT CONTRACTS AS COLLECTIVE GROUPS RATHER THAN INDIVIDUALLY. THE FINANCIAL STATEMENT EFFECTS OF USING THIS PRACTICAL EXPEDIENT ARE NOT MATERIALLY DIFFERENT FROM AN INDIVIDUAL CONTRACT APPROACH.THE PRIMARY COLLECTIONS RISKS RELATE TO UNINSURED PATIENT ACCOUNTS, INCLUDING PATIENT ACCOUNTS FOR WHICH THE PRIMARY INSURANCE CARRIER HAS PAID THE AMOUNTS COVERED BY THE APPLICABLE AGREEMENT, BUT THE PATIENT RESPONSIBILITY AMOUNT (DEDUCTIBLES AND COPAYMENTS) REMAIN OUTSTANDING. IMPLICIT PRICE CONCESSIONS RELATE PRIMARILY TO AMOUNTS DUE DIRECTLY FROM PATIENTS. ESTIMATED IMPLICIT PRICE CONCESSIONS ARE RECORDED FOR ALL UNINSURED ACCOUNTS, REGARDLESS OF THE AGING OF THOSE ACCOUNTS. ACCOUNTS ARE WRITTEN OFF WHEN ALL REASONABLE INTERNAL AND EXTERNAL COLLECTION EFFORTS HAVE BEEN PERFORMED.FROM FOOTNOTE 3 OF THE AUDITED FINANCIAL STATEMENTS: GENERALLY, PATIENTS WHO ARE COVERD BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE HOSPITAL ALSO PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJSUTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMNETS TO PATIENT SERVICES REVENUE IN THE PRIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD-DEBT EXPENSE. |
| PART III, LINE 8: | THE COSTING METHODOLOGY USED IN DETERMINING THE MEDICARE ALLOWABLE COST REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6:THE HOSPITAL FOLLOWED MEDICARE'S PRESCRIBED METHODS OF DETERMINING COSTS PAYABLE UNDER TITLE XVIII (MEDICARE) IN COMPLETING ITS ANNUAL MEDICARE COST REPORT (COST REPORT) USING DATA AVAILABLE FROM THE INSTITUTION'S BASIC ACCOUNTS, AS USUALLY MAINTAINED, TO ARRIVE AT EQUITABLE AND PROPER PAYMENT FOR SERVICES. THE COST REPORT WAS COMPLETED USING THE HOSPITAL'S TRIAL BALANCE OF EXPENSES, AS WELL AS OTHER STATISTICAL AND FINANCIAL RECORDS MAINTAINED BY THE HOSPITAL. AS REQUIRED BY MEDICARE REGULATIONS, CERTAIN RECLASSIFICATIONS AND ADJUSTMENTS TO COSTS WERE INCLUDED IN THE COST REPORT TO DETERMINE MEDICARE ALLOWABLE COSTS.AFTER MEDICARE ALLOWABLE COSTS ARE DETERMINED, THE COST REPORT PROVIDES FOR THE STEP DOWN METHOD OF COST FINDING. THIS METHOD PROVIDES FOR ALLOCATING THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS, WHICH UTILIZE THE SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. AFTER ALL COSTS OF THE GENERAL SERVICE COST CENTERS HAVE BEEN ALLOCATED TO THE REMAINING COST CENTERS, THE TOTAL COSTS OF THESE REMAINING COST CENTERS ARE FURTHER DISTRIBUTED TO THE DEPARTMENTAL CLASSIFICATION TO WHICH THEY PERTAIN, E.G., HOSPITAL GENERAL INPATIENT ROUTINE, SUBPROVIDER, ANCILLARY, ETC.AFTER THE STEP-DOWN PROCESS, THE COST REPORT PROVIDES FOR THE APPORTIONMENT OF COSTS TO THE MEDICARE PROGRAM BASED ON A NUMBER OF DIFFERENT METHODOLOGIES INCLUDING PER PATIENT DAY, PER VISIT, AND PERCENTAGE OF CHARGES, AS MOST PREVALENT. MEDICARE COSTS AS DETERMINED BY THE COST REPORT METHODOLOGIES DESCRIBED PREVIOUSLY WERE UTILIZED TO COMPLETE THE APPLICABLE MEDICARE ALLOWABLE COSTS OF CARE FOR SCHEDULE H (FORM 990) PART III SECTION B LINE 6. |
| PART III, LINE 9B: | AT LEAST 30 DAYS PRIOR TO TAKING ANY EXTRAORDINARY COLLECTION ACTION AGAINST AN INDIVIDUAL TO OBTAIN PAYMENT FOR AN EPISODE OF CARE, EBCH OR ITS AGENT SHALL PROVIDE THE INDIVIDUAL WITH A WRITTEN NOTICE THAT INCLUDES THE FOLLOWING INFORMATION:I. CHARITY CARE - FINANCIAL ASSISTANCE PROGRAM (FAP) IS AVAILABLE FOR ELIGIBLE INDIVIDUALS.II. THE EXTRAORDINARY COLLECTION ACTIONS THAT EBCH INTENDS TO INITIATE FOR PAYMENT OF CARE.III. A DEADLINE AFTER WHICH EXTRAORDINARY COLLECTION ACTIONS MAY BE INITIATED.BEFORE SENDING AN ACCOUNT TO A COLLECTION AGENCY, EBCH MAY USE INFORMATION PROVIDED BY AN OUTSIDE AGENCY OR VENDOR TO DETERMINE ELIGIBILITY AND POTENTIAL FINANCIAL ASSISTANCE. THESE AGENCIES MAY USE PUBLICLY AVAILABLE AND PURCHASED TRANSACTION DATA TO ESTIMATE A GUARANTOR'S FINANCIAL PROFILE AND HOUSEHOLD SIZE. EXAMPLES OF SUCH DATA ARE CENSUS DATA, BIRTH CERTIFICATES, MARRIAGE LICENSES, LEGAL NOTICES, BANKRUPTCY FILINGS, AUTOMOBILE REGISTRATIONS, PROPERTY TAX RECORDS, AS WELL AS POINT-OF-SALES TRANSACTIONS DATA THAT RETAILERS AND CREDIT CARD COMPANIES MAKE AVAILABLE FOR PURCHASE TO PRESUMPTIVELY DETERMINE WHETHER THAT INDIVIDUAL MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER EBCH'S FINANCIAL ASSISTANCE POLICY.IF THE INDIVIDUAL IS PRESUMPTIVELY DETERMINED TO BE ELIGIBLE FOR A 100% DISCOUNT (COMPLETE WRITE-OFF) UNDER EBCH'S FINANCIAL ASSISTANCE POLICY, EBCH SHALL INFORM THE INDIVIDUAL OF THAT DECISION AND NO FURTHER ACTIONS WILL BE TAKEN IN RELATION TO MEDICAL SERVICES TO WHICH THIS FINANCIAL ASSISTANCE APPLIES. |
| PART VI, LINE 2: | NEEDS ASSESSMENT:ELY BLOOMENSON UTILIZES THE BRIDGES TO HEALTH SURVEY FIRST CONDUCTED IN 1995 AND THUS COMPLETED EVERY FIVE YEARS: 2000, 2005, 2010, 2015, 2020. THE SURVEY, A COLLABORATIVE EFFORT AMONG REGIONAL HEALTH ORGANIZATIONS, IS A TRUSTED SOURCE OF POPULATION-BASED HEALTH STATUS INFORMATION USED TO IMPROVE THE HEALTH OF PEOPLE THROUGHOUT NORTHEASTERN MINNESOTA.THE HOSPITAL HELD THREE SESSIONS OF ITS COMMUNITY FORUM IN ELY, BABBITT, AND TOWER IN THE SPRING TO ENCOURAGE THE COMMUNITY TO GET AN UPDATE OF WHAT THEY ARE DOING AT THE HOSPITAL, AND THE HOSPITAL LISTENS TO QUESTIONS AND SUGGESTIONS FOR THE COMMUNITY. THE 2019 SESSIONS TOOK PLACE IN ELY ON 4/24/2019, BABBITT ON 5/23/2019, AND TOWER ON 6/27/2019.IN THE SUMMER OF 2021, EBCH PARTICIPATED IN COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) SERVICES ADMINISTRATED BY RURAL HEALTH INNOVATIONS (RHI), A SUBSIDIARY OF THE NATIONAL RURAL HEALTH RESOURCE CENTER. RHI CONFERRED WITH LEADERS FROM EBCH TO DISCUSS THE OBJECTIVES OF A REGIONAL CHNA. A MAILED SURVEY INSTRUMENT WAS DEVELOPED TO ASSESS THE HEALTH CARE NEEDS AND PREFERENCES IN THE SERVICE AREA. THIS WAS COMPLETED IN NOVEMBER 2021.THE HOSPITAL ALSO RECEIVES QUESTIONS AND SUGGESTIONS FROM THE COMMUNITY THROUGH THE "CONTACT US" PAGE OF THEIR WEBSITE, THE EBCH FACEBOOK PAGE, AND AT VARIOUS SPEAKING ENGAGEMENTS FOR THEIR LOCAL SERVICE CLUBS AND ORGANIZATIONS, SUCH AS THE ROTARY, LIONS, AND KIWANIS. |
| PART VI, LINE 3: | PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:THE ELY BLOOMENSON HOSPITAL STAFF ENCOURAGES ANY PATIENT WITH NO INSURANCE TO TALK TO ST. LOUIS COUNTY SOCIAL SERVICES TO FIND OUT ABOUT MEDICAL ASSISTANCE OR MN CARE ELIGIBILITY. ON ALL PATIENT STATEMENTS, THERE ARE DIRECTIONS ON HOW TO ACCESS THE CREDIT AND COLLECTION POLICY AS WELL AS THE FINANCIAL ASSISTANCE POLICY. THE FINANCIAL ASSISTANCE POLICY INFORMS PATIENTS THAT WE HAVE AN INCOME BASED CHARITY CARE POLICY AND THEY CAN CONTACT THE EBCH FINANCIAL COUNCILOR OR BUSINESS OFFICE FOR AN APPLICATION. APPLICATIONS AND POLICIES ARE AVAILABLE ON THE HOPITAL'S WEBSITE AT EBCH.ORG. WHEN AN ACCOUNT IS PAST DUE A SERIES OF COLLECTION LETTERS GO OUT WITH THE MESSAGE THAT THE ELY BLOOMENSON HOSPITAL HAS AN INCOME BASED CHARITY CARE POLICY AND IF ANYONE WOULD LIKE AN APPLICATION OR IF ANYONE HAS A QUESTION ABOUT IT THEY SHOULD CONTACT THE EBCH FINANCIAL COUNCILOR OR THE BUSINESS OFFICE. ALL PATIENTS SHOULD BE AWARE OF THE CHARITY CARE OPTION BEFORE THE ACCOUNT TURNS INTO BAD DEBT STATUS. |
| PART VI, LINE 4: | COMMUNITY INFORMATION:ELY, A CITY OF 2.7 SQUARE MILES, AND THE SURROUNDING COMMUNITIES OF WINTON, BABBITT, TOWER AND ISABELLA CONSTITUTES A LARGE RURAL DEMOGRAPHIC REGION IN NORTHEASTERN MINNESOTA BORDERING THE 1.5 MILLION ACRES OF THE BOUNDARY WATERS CANOE AREA WILDERNESS (BWCAW). THE CITY OF DULUTH, 120 MILES SOUTHWEST AND VIRGINIA, 50 MILES WEST, SERVE AS THE NEAREST HEALTH CARE CENTERS. THE HOSPITAL SERVES A YEAR ROUND POPULATION OF APPROXIMATELY 8,600. IN ADDITION, THE COMMUNITY ANNUALLY SERVES OVER 125,000 VISITORS SEEKING A WILDERNESS EXPERIENCE. ACCORDING TO THE 2020 CENSUS, ELY, MN HAD A POPULATION OF 3.34K PEOPLE WITH A MEDIAN AGE OF 52.4 AND A MEDIAN HOUSEHOLD INCOME OF $37,317. BETWEEN 2019 AND 2020 THE POPULATION OF ELY, MN DECLINED FROM 3,390 TO 3,338, A 1.53% DECREASE AND ITS MEDIAN HOUSEHOLD INCOME DECLINED FROM $40,946 TO $37,317, A 8.86% DECREASE.THE 5 LARGEST ETHNIC GROUPS IN ELY, MN ARE WHITE (NON-HISPANIC) (95.1%), TWO+ (HISPANIC) (1.98%), BLACK OR AFRICAN AMERICAN (NON-HISPANIC) (1.11%), AMERICAN INDIAN & ALASKA NATIVE (NON-HISPANIC) (0.989%), AND OTHER (HISPANIC) (0.33%). NONE OF THE HOUSEHOLDS IN ELY, MN REPORTED SPEAKING A NON-ENGLISH LANGUAGE AT HOME AS THEIR PRIMARY SHARED LANGUAGE. THIS DOES NOT CONSIDER THE POTENTIAL MULTI-LINGUAL NATURE OF HOUSEHOLDS, BUT ONLY THE PRIMARY SELF-REPORTED LANGUAGE SPOKEN BY ALL MEMBERS OF THE HOUSEHOLD. 99.6% OF THE RESIDENTS IN ELY, MN ARE U.S. CITIZENS. THE LARGEST UNIVERSITIES IN ELY, MN ARE VERMILION COMMUNITY COLLEGE (185 DEGREES AWARDED IN 2020).IN 2020, THE MEDIAN PROPERTY VALUE IN ELY, MN WAS $119,400, AND THE HOMEOWNERSHIP RATE WAS 58.2%. |
| PART VI, LINE 5: | PROMOTION OF COMMUNITY HEALTH:ELY BLOOMENSON DOES HAVE AN OPEN MEDICIAL STAFF ALLOWING A VARIETY OF PHYSICIANS TO PRACTICE BENEFITING THE COMMUNITY AND CITIZENS OF THE SURROUNDING AREA. THE COMMUNITY HEALTH COUNCIL, BRINGING HEALTH AND WELLNESS TO THE FOREFRONT IN ELY AND SURROUNDING COMMUNITIES THROUGH VARIOUS INITIATIVE AND SERVICES, MEETS AND IS PARTIALLY FUNDED THROUGH THE HOSPITAL. PROVIDES FUNDING FOR ELY, BABBITT, AND TOWER SOUDAN HIGH SCHOOL GRADUATION ACTIVITIES. FRUNDING PROVIDED FOR CHILDREN'S PROGRAMS SPONSORED BY THE ELY POLICE, ELY FIRE DEPARTMENTS, AND LOCAL SCHOOLD DISTRCT ISD# 696. THE HOSPITAL RECORDS DAILY RADIO SPOTS PROMOTING HEALTH AND WELLNESS. CONSULTATION SERVICES FOR THE MANY NON PROFIT ORGANIZATIONS SPECIFICALLY HOSPICE/RESPITE AND MENTAL ILLNESS PROGRAMS. TWO BLOOD DRIVES ARE ADMINISTERED ANNUALLY THROUGH ELY BLOOMENSON. ELY BLOOMENSON COMMUNITY HOSPITAL IS THE HEART OF THE CITY. |
| PART VI, LINE 6: | AFFILIATED HEALTH CARE SYSTEM:N/A |
| PART VI, LINE 7, REPORTS FILED WITH STATES | MN |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ELY AREA AMBULANCE SERVICE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 205 NORTH CENTRAL AVENUE | AddressLine1Txt |
| City | ELY | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55731 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 262472853 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $5,928 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | OPERATIONS SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ALL GRANTS ARE PAID DIRECTLY TO U.S. GRANT RECIPIENTS. THERE IS NO FURTHER MONITORING OF GRANT FUNDS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BROCK URIE | ||||||||||||||
| CMO/PHYSICIAN | $418,927 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $418,927 | $0 | $0 | $0 |
| PATTI BANKS | ||||||||||||||
| CEO | $248,553 | $0 | $0 | $0 | $129 | $0 | $10,255 | $0 | $32,947 | $0 | $291,884 | $0 | $0 | $0 |
| SAM RICE | ||||||||||||||
| PHYSICIAN | $195,241 | $0 | $0 | $0 | $0 | $0 | $8,535 | $0 | $24,106 | $0 | $227,882 | $0 | $0 | $0 |
| KARLA GRIZZARD | ||||||||||||||
| RN | $182,555 | $0 | $0 | $0 | $198 | $0 | $7,422 | $0 | $29,871 | $0 | $220,046 | $0 | $0 | $0 |
| JOHN SCHINDELE | ||||||||||||||
| PHARMACIST | $157,773 | $0 | $18,178 | $0 | $129 | $0 | $6,604 | $0 | $36,963 | $0 | $219,647 | $0 | $0 | $0 |
| BETH HARTSHORN | ||||||||||||||
| PHARMACIST | $160,059 | $0 | $0 | $0 | $27 | $0 | $6,402 | $0 | $10,084 | $0 | $176,572 | $0 | $0 | $0 |
| ABIGAIL SIREK | ||||||||||||||
| PHARMACIST | $150,381 | $0 | $0 | $0 | $18 | $0 | $6,015 | $0 | $9,977 | $0 | $166,391 | $0 | $0 | $0 |
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 ELY MINNESOTA | |||||||
| A | 416005133 | 2015-03-23 | $7,680,415 | SRS 2015A - REFUNDING OF 10/28/2008 NOTES | 0 | 0 | 0 |
| CITY OF ELY MINNESOTA | |||||||
| B | 416005133 | 2015-03-23 | $4,287,460 | SRS 2015B - REFUNDING OF 10/28/2008 NOTES | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Other Spent ProceedsOtherSpentProceedsAmt | Substantial CompletionSubstantialCompletionYr | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|
| A | $2,396,672 | $7,680,415 | $153,605 | $7,526,810 | 2009 | Yes (1) | 0 | Yes (1) | Yes (1) |
| B | $4,043,470 | $4,287,460 | $85,746 | $4,201,714 | 2009 | Yes (1) | 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 | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 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 | 0 | Yes (1) | 0 | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART IV, LINE 3 | FormAndLineReferenceDesc |
| Explanation | FOR NOTE A THE INTEREST RATE IS FIXED EXCEPT THAT ON THE SIXTY-FOURTH AND ONE HUNDRED TWENTY-EIGHTH PAYMENT DATES THE INTEREST RATE HEREON SHALL BE ADJUSTED TO A PER ANNUM INTEREST RATE EQUAL TO .67 TIMES THE SUM OF THE 5 YEAR LIBOR/SWAP RATE AND 2.65%, PROVIDED THAT THE ACTUAL INCREASE IN THE ANNUAL RATE HEREON ON ANY ADJUSTMENT DATE, MAY NOT EXCEED 1.5% AND THE ANNUAL RATE HEREON CAN NEVER BE LESS THAN 2.91%. FOR NOTE B THE INTEREST RATE IS FIXED EXCEPT THAT ON THE SIXTY-FOURTH PAYMENT DATE THE INTEREST RATE HEREON SHALL BE ADJUSTED TO A PER ANNUM INTEREST RATE EQUAL TO .67 TIMES THE SUM OF THE 5 YEAR LIBOR/SWAP RATE AND 2.65%, PROVIDED THAT THE ACTUAL INCREASE IN THE ANNUAL RATE HEREON ON ANY ADJUSTMENT DATE, MAY NOT EXCEED 1.5% AND THE ANNUAL RATE HEREON CAN NEVER BE LESS THAN 2.78%. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE ELY HEATH AND HOSPITAL FOUNDATION IS THE SOLE MEMBER OF THE ELY-BLOOMENSON COMMUNITY HOSPITAL. THE ELY HEALTH AND HOSPITAL FOUNDATION HAS OVER 670 MEMBERS; ANY RESIDENT OF THE AREA SERVED BY THE HOSPITAL MAY BECOME A MEMBER WITH A PAYMENT OF $100. |
| FORM 990, PART VI, SECTION A, LINE 7A | ELY HEALTH AND HOSPITAL FOUNDATION (SOLE MEMBER OF EBCH) ELECTS ALL BOARD MEMBERS OF THE HOSPITAL. |
| FORM 990, PART VI, SECTION A, LINE 7B | THERE ARE CERTAIN ISSUES THAT MUST BE APPROVED BY ALL MEMBERS, SUCH AS BY-LAW CHANGES AND TRANSFER OF SUBSTANTIAL AMOUNTS OF ASSETS. ALL MEMBERS HAVE VOTING RIGHTS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 IS REVIEWED BY THE CFO AND PRESENTED TO THE BOARD MEMBERS AT A BOARD MEETING PRIOR TO ITS FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | DEFINITION OF CONFLICT: A CONFLICT OF INTEREST SHALL EXIST AT ANY TIME THAT A CONTRACT OR OTHER TRANSACTION EXISTS OR IS PROPOSED BETWEEN ELY-BLOOMENSON COMMUNITY HOSPITAL AND ONE OF ITS DIRECTORS OR BETWEEN ONE OF ITS DIRECTORS AND A RELATED ORGANIZATION, OR BETWEEN ELY-BLOOMENSON COMMUNITY AND AN ORGANIZATION IN OR OF WHICH A DIRECTOR OF ELY-BLOOMENSON COMMUNITY HOSPITAL IS ALSO A DIRECTOR, OFFICER OR LEGAL REPRESENTATIVE OR HAS MATERIAL FINANCIAL INTERESTS. A DIRECTOR OF ELY-BLOOMENSON COMMUNITY HOSPITAL HAS A MATERIAL FINANCIAL INTEREST IN AN ORGANIZATION WHICH THE DIRECTOR OR THE SPOUSE, PARENTS, CHILDREN AND SPOUSES OF CHILDREN, BROTHER AND SISTER AND SPOUSES OF BROTHERS AND SISTERS OF THE DIRECTOR, HAVE A MATERIAL FINANCIAL INTEREST. DECLARATION OF CONFLICT OF INTEREST: EACH DIRECTOR OF ELY-BLOOMENSON COMMUNITY HOSPITAL IS EXPECTED TO DECLARE A CONFLICT OF INTEREST AS SOON AS THE DIRECTOR IS AWARE OF SUCH CONFLICT. ONCE A CONFLICT OF INTEREST HAS BEEN DECLARED THE BOARD OF DIRECTORS SHALL FOLLOW THE PROCEDURE OUTLINED IN THE PROCEDURE PARAGRAPH OF THIS POLICY. DETERMINATION OF CONFLICT OF INTEREST: ANY OFFICER OR MEMBER OF THE BOARD OF DIRECTORS OF ELY-BLOOMENSON COMMUNITY HOSPITAL WHO BELIEVES THAT A BOARD MEMBER HAS A CONFLICT OF INTEREST SHALL STATE TO THE BOARD OF DIRECTORS THE BASIS FOR SUCH BELIEF. IF THE PERSON BELIEVED TO HAVE THE CONFLICT OF INTEREST DOES NOT AGREE THAT SUCH A CONFLICT EXISTS, SUCH PERSON SHALL BE GIVEN AN OPPORTUNITY TO RESPOND. IF IT IS NOT AGREED THAT A CONFLICT DOES EXIST THEN THE BOARD OF DIRECTORS SHALL VOTE TO DETERMINE WHETHER OR NOT SUCH CONFLICT EXISTS. ANY DIRECTOR WHO IS ENTITLED TO VOTE MAY REQUEST THAT THE VOTE BE BY CLOSED BALLOT AND UPON SUCH REQUEST THE CHAIRPERSON SHALL DECLARE THE VOTE BY CLOSED BALLOT. A SIMPLE MAJORITY OF THE MEMBERS PRESENT AND VOTING SHALL BE SUFFICIENT TO ESTABLISH THAT A CONFLICT OF INTEREST DOES EXIST. PROCEDURE UPON DETERMINATION OF CONFLICT: ONCE A CONFLICT OF INTEREST HAS BEEN DECLARED OR DETERMINED BY THE BOARD, THE INTERESTED PERSON OR PERSONS SHALL BE EXCUSED FROM THE MEETING UNTIL SUCH TIME AS A VOTE HAS BEEN TAKEN BY THE BOARD IN REGARD TO THE ISSUE IN WHICH THE INTERESTED MEMBER HAS A CONFLICT. ONCE A CONFLICT OF INTEREST HAS BEEN DECLARED OR DETERMINED, THE INTERESTED MEMBER SHALL NOT PARTICIPATE IN ANY DISCUSSION IN REGARD TO THE SUBJECT MATTER AND MAY ONLY RESPOND TO QUESTIONS DIRECTED TO HIM/HER BY ANY ONE OR MORE THE DIRECTORS. THE INTERESTED DIRECTOR SHALL NOT BE COUNTED IN THE QUORUM AND SHALL ABSTAIN FROM VOTING. THE STATEMENT REGARDING THE CONFLICT OF INTEREST MUST BE ENTERED INTO THE MINUTES. ONCE A DIRECTOR OR OFFICER HAS DECLARED OR BEEN DETERMINED TO HAVE A CONFLICT OF INTEREST, SUCH CONFLICT SHALL BE DEEMED TO CONTINUE UNTIL THE FINAL VOTE HAS BEEN TAKEN BY THE BOARD OF DIRECTORS IN REGARD TO THE SUBJECT MATTER IN WHICH SUCH DIRECTOR HAS A CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THERE IS A BOARD LEVEL COMPENSATION COMMITTEE, MADE UP OF INDEPENDENT DIRECTORS, THAT MEETS ANNUALLY AND REVIEWS AND COMPARES THE COMPENSATION OF THE CEO, CFO, COO, CHRO & CNO WITH VARIOUS COMPENSATION STUDIES OF HOSPITALS OUR SIZE, SUCH AS THE MINNESOTA HOSPITAL ASSOCIATION ANNUAL SURVEY. THIS COMMITTEE IS APPRAISED OF 990 DISCLOSURE REQUIREMENTS. THE CEO MAKES RECOMMENDATIONS TO THE COMMITTEE REGARDING THE COMPENSATION OF THE CFO AND CNO BASED ON VARIOUS COMPENSATION STUDIES. THE COMPENSATION COMMITTEE THEN MAKES RECOMMENDATIONS TO THE FULL BOARD IN CLOSED SESSION AND MINUTES ARE KEPT OF SAID MEETING. THE MINUTES AND ALL MATERIALS RELATED TO THE COMPENSATION DECISIONS ARE KEPT ON FILE WITH THE HOSPITAL'S ATTORNEY'S OFFICE. OTHER POSITIONS RELY ON THE HEALTHCARE HUMAN RESOURCES ASSOCIATION OF MINNESOTA (HHRAM) SURVEY AND ANNUAL BUDGET REQUESTS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. ANNUAL FINANCIAL REPORTS ARE PROVIDED TO ALL SHAREHOLDERS WHO ATTEND THE ANNUAL MEETING OR UPON REQUEST. OTHER DOCUMENTS WILL BE PROVIDED TO MEMBERS UPON REQUEST. THE ANNUAL FINANCIAL REPORT WILL BE GIVEN TO THE GENERAL PUBLIC IF REQUESTED DURING THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). |
| FORM 990, PART IX, LINE 11G | OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 4,159,541. MANAGEMENT AND GENERAL EXPENSES 1,042,704. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,202,245. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ELY HEALTH & HOSPITAL FOUNDATION | |||||||||||
| 328 W CONAN STREET | ELY | MN | 55731 | 412001411 | TO PROVIDE SUPPORT TO ELY-BLOOMENSON COMMUNITY HOSPITAL FOR HEALTHCARE | MN | 501(C)(3) | LINE 12B, II | N/A | 0 | |
| ELY HEALTH & HOSPITAL FUND | |||||||||||
| 328 W CONAN STREET | ELY | MN | 55731 | 461836177 | TO PROVIDE SUPPORT TO ELY-BLOOMENSON COMMUNITY HOSPITAL FOR HEALTHCARE | MN | 501(C)(3) | LINE 12B, II | 0 | ELY HEALTH & HOSPITAL FOUNDATION | |
| 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 | 0 | 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 | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |