MCKENZIE COUNTY HEALTHCARE SYSTEMS INC: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- MCKENZIE COUNTY HEALTHCARE SYSTEMS INC (EIN 77-0637498)
- Tax period
- 2018-07-01 to 2019-06-30
- Filed
- 2020-06-03
- IRS object ID
- 202011559349300021
- Schema version
- 2018v3.1
- 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 L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-06-03T08:56:39-05:00 | ReturnTs |
| Tax Period End | 2019-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 770637498 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE COUNTY HEALTHCARE SYSTEMS INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MCKE | BusinessNameControlTxt |
| Phone | 7018423000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 709 4TH AVENUE NE | AddressLine1Txt |
| City | WATFORD CITY | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58854 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DANIEL KELLY | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7018423000 | PhoneNum |
| Signature | 2020-06-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2020-06-02 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 71.13.38.61 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-06-02 | IPDt |
| IP Tm | 13:19:44 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 9747BB8E0DC0E78824B7C9EDF76D609BB7F00C05 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DANIEL KELLY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 709 4TH AVENUE NE | AddressLine1Txt |
| City | WATFORD CITY | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58854 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $28,463,870 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MCKENZIEHEALTH.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2004 | FormationYr |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Activity Or Mission | HEALTH CARE SERVICE PROVIDER. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 253 | TotalEmployeeCnt |
| Total Volunteers | 45 | TotalVolunteersCnt |
| Total Gross UBI | $339,000 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $9,454,505 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,155,508 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $16,958,938 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $23,686,488 | CYProgramServiceRevenueAmt |
| PY Investment Income | $25,841 | PYInvestmentIncomeAmt |
| CY Investment Income | $14,735 | CYInvestmentIncomeAmt |
| PY Other Revenue | $566,306 | PYOtherRevenueAmt |
| CY Other Revenue | $726,853 | CYOtherRevenueAmt |
| PY Total Revenue | $27,005,590 | PYTotalRevenueAmt |
| CY Total Revenue | $27,583,584 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $50 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,054,012 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $11,260,469 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,318,302 | PYOtherExpensesAmt |
| CY Other Expenses | $19,555,007 | CYOtherExpensesAmt |
| PY Total Expenses | $19,372,314 | PYTotalExpensesAmt |
| CY Total Expenses | $30,815,526 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $7,633,276 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$3,231,942 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $112,115,780 | TotalAssetsBOYAmt |
| Total Assets EOY | $115,957,319 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $71,789,271 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $78,862,752 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $40,326,509 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $37,094,567 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | MCKENZIE COUNTY HEALTHCARE SYSTEMS IS A FAITH-BASED ORGANIZATION DEDICATED TO PROFESSIONAL, COMPASSIONATE AND QUALITY HEALTHCARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $18,333,277 | ExpenseAmt |
| Grant | $50 | GrantAmt |
| Revenue | $16,826,989 | RevenueAmt |
| Desc | MCKENZIE COUNTY HEALTHCARE SYSTEMS PROVIDES 24 HOUR X 7 DAYS A WEEK SERVICES. MCHS PROVIDED IN-PATIENT, OBSERVATION, AND SWING BED SERVICES - HOSPITAL- TOTAL INPATIENT/OBSERVATION DAYS - 468. TOTAL SWING BED DAYS - 639. MCHS OFFERS VARIOUS OTHER SERVICES. THEY OFFER ENDOSCOPIC EXAMS ONCE A MONTH BY A CONTRACTED PROVIDER. TOTAL OUTPATIENT SURGERIES - 136. THE EMERGENCY ROOM IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK. TOTAL EMERGENCY ROOM VISITS - 5,158. THE LABORATORY IS LOCATED WITHIN THE HOSPITAL FACILITY. BIRTHDAY LAB SCREENINGS ARE AVAILABLE TO THE COMMUNITY AT THE HOSPITAL AT A REDUCED RATE. NUMBER OF MEMBERS TAKING ADVANTAGE OF BIRTHDAY SCREENINGS - 581. TOTAL OUTPATIENT PROCEDURES - 19,906. VOLUME INCREASED DUE TO POPULATION INCREASE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $4,410,555 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $4,048,177 | RevenueAmt |
| Desc | THE MCKENZIE COUNTY HEALTHCARE SYSTEM (MCHS) GOOD SHEPHERD HOME (GSH) IS A 47 BED SKILLED NURSING HOME WITH AN ATTACHED 9-BED BASIC CARE UNIT. BASIC CARE WAS CLOSED DUE TO CONSTRUCTION IN FEBRUARY 2018 AND WILL REOPEN IN JULY 2020. THE GSH OFFERS DAY CARE AND/OR RESPITE CARE FOR THOSE CARING FOR A LOVED ONE IN THEIR HOME. A DEMENTIA SUPPORT GROUP IS OFFERED TO FAMILIES. THEY MAINTAIN REGULAR RESIDENT FAMILY COUNCIL MEETINGS. ALONG WITH QUALIFIED NURSING CARE AND STAFF, SOCIAL SERVICES, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, RESTORATIONAL NURSING, LAUNDRY, HOUSEKEEPING, BEAUTICIAN SERVICES, AND ACTIVITY PROGRAMS ARE OFFERED. VISITORS ARE ALWAYS WELCOME AS WELL AS CHILDREN. CHILDREN ARE WELCOME TO VISIT AND PLAY ON THE FENCED OUTDOOR PLAYGROUND EQUIPMENT. PASTORAL CARE AND CHAPEL ARE OFFERED 7 DAYS A WEEK. ACTIVITIES INCLUDE BIRTHDAY PARTIES, MUSICAL GROUPS, BAKING, AND BUS TRIPS. THE SKILLED NURSING TOTAL PERCENT OF OCCUPANCY HAS BEEN 75.10%. THE BASIC CARE UNIT TOTAL PERCENT OF OCCUPANCY HAS BEEN 0% WHILE THE SPACE IS CLOSED FOR RENOVATIONS. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,776,327 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $2,548,220 | RevenueAmt |
| Desc | THE MCHS CLINIC (RURAL HEALTH CLINIC) MAINTAINS THE SAME MISSION AS THE HOSPITAL. IT PROVIDES CARE MONDAY THROUGH FRIDAY. A FULL-TIME CONTRACTED LOCUM PHYSICIAN GROUP PROVIDE EMERGENCY ROOM COVERAGE AT THE HOSPITAL 24 HOURS A DAY X 7 DAYS A WEEK AS WELL AS 7 DAY A WEEK URGENT CARE COVERAGE FROM 8A TO 8P UTILIZING MID-LEVEL PROVIDERS. RHC PROVIDERS, DR. RAMAGE, DR. LOONEY, DR. MUDORF, JESSICA HEGGEN, AND JANICE GREEN ALSO MAKE VISITS TO THE GOOD SHEPHERD HOME WEEKLY. BOTH THE VALUE BASED PROGRAM INVOLVEMENT AS WELL AS OUR VISITING NURSE PROGRAM HAVE BEEN A GREAT ASSET TO THE CLINIC, PROVIDING CARE TO HOMEBOUND PATIENTS WITHIN OUR COMMUNITY. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp (2 entries)
| ExpenseExpenseAmt | GrantGrantAmt | RevenueRevenueAmt | DescDesc |
|---|---|---|---|
| $255,193 | $0 | $234,226 | HORIZON ASSISTED LIVING PROVIDES ASSISTED AND INDEPENDENT LIVING SERVICES. IT CONSISTS OF 15 APARTMENTS THAT PROVIDE A 24 HOUR CALL SYSTEM TO HEALTH CARE PERSONNEL. THE STAFF IS DEDICATED TO HELPING SENIORS LIVE AT THEIR HIGHEST LEVEL OF INDEPENDENCE AND ABILITY. ITS PERCENT OF OCCUPANCY IS CURRENTLY AT 59.30% |
| $394,851 | $0 | $0 | WELLNESS CENTER |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $650,044 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $234,226 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $26,170,203 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 49 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 253 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DANIEL KELLY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7018423000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 709 4TH AVENUE NE | AddressLine1Txt |
| City | WATFORD CITY | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58854 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| MONTY BULZOMI | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| VIRGINIA CEYNAR | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JAN DODGE | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | 2.00 | ||
| TAMMY JAMES | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| NANCY JELLESED | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| LARRY LARSEN | ||||||||
| DIRECTOR (THRU NOV) | 1.00 | Yes (X) | $0 | $0 | $0 | 2.00 | ||
| NEAL SHIPMAN | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| PATSY LEVANG | ||||||||
| PRESIDENT | 2.00 | Yes (X) | $0 | $0 | $0 | 2.00 | Yes (X) | |
| MYRON HOVET | ||||||||
| VICE PRESIDENT | 2.00 | Yes (X) | $0 | $0 | $0 | 2.00 | Yes (X) | |
| KELLY PETERSON | ||||||||
| VICE PRESIDENT (THRU NOV) | 2.00 | Yes (X) | $0 | $0 | $0 | 2.00 | Yes (X) | |
| MICHON SAX | ||||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| SCOTT SWENSON | ||||||||
| TREASURER | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| DANIEL KELLY | ||||||||
| CEO | 40.00 | $495,748 | $0 | $22,193 | 10.00 | Yes (X) | ||
| SUSIE CURTIS | ||||||||
| CFO | 40.00 | $97,546 | $0 | $3,998 | Yes (X) | |||
| CHERYL FAULKNER | ||||||||
| CNO | 40.00 | $110,949 | $0 | $11,397 | Yes (X) | |||
| MICHAEL CURTIS | ||||||||
| CAO | 40.00 | $123,938 | $0 | $17,730 | Yes (X) | |||
| DR GARY RAMAGE | ||||||||
| PHYSICIAN | 40.00 | $343,420 | $0 | $17,548 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,171,601 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $72,866 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | 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 |
|---|---|---|---|---|---|
| JE DUNN | |||||
| 800 WASHINGTON AVE N STE 600 | MINNEAPOLIS | MN | 55401 | CONSTRUCTION SERVICES | $9,604,456 |
| RURAL MEDICAL PARTNERS | |||||
| 4956 CURRAN COURT | GRAND FORKS | ND | 58201 | CONTRACT MEDICAL STAFF | $1,995,235 |
| HANNAHERS | |||||
| 3803 MAIN AVE | FARGO | ND | 58103 | INTERIOR DESIGN | $618,797 |
| GE HEALTHCARE | |||||
| PO BOX 96483 | CHICAGO | IL | 60693 | IT SERVICES | $544,960 |
| EQUALIZE RCM SERVICES | |||||
| PO BOX 679005 | DALLAS | TX | 75267 | MEDICAL BILLING SERVICES | $535,764 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 37 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $1,875,001 | RelatedOrganizationsAmt |
| Government Grants | $1,278,617 | GovernmentGrantsAmt |
| All Other Contributions | $1,890 | AllOtherContributionsAmt |
| Total Contributions | $3,155,508 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| HOSPITAL PATIENT SERVICE REVENUE | 621400 | $16,219,931 | $16,219,931 | ||
| NURSING HOME SERVICE REVENUE | 621400 | $4,048,177 | $4,048,177 | ||
| CLINIC SERVICE REVENUE | 621400 | $2,548,220 | $2,548,220 | ||
| WELLNESS CENTER | 621400 | $635,934 | $514,656 | $121,278 | |
| ASSISTED LIVING SERVICE REVENUE | 621400 | $234,226 | $234,226 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $23,686,488 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,735 | TotalRevenueColumnAmt |
| Exclusion | $14,735 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $771,741 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $880,286 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$108,545 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$108,545 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | -$175,656 | UnrelatedBusinessRevenueAmt |
| Exclusion | $67,111 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| 340 B REVENUE | 621400 | $579,120 | $579,120 | |
| EHR INCENTIVE | 621400 | $27,938 | $27,938 | |
| CAFETERIA AND DIETARY REVENUE | 900099 | $26,165 | $26,165 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $202,175 | TotalRevenueColumnAmt |
| Exclusion | $202,175 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $835,398 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $27,583,584 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $23,657,612 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $339,000 | UnrelatedBusinessRevenueAmt |
| Exclusion | $431,464 | 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 | $50 | TotalAmt |
| Program Services | $50 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $906,106 | TotalAmt |
| Management And General | $906,106 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,583,723 | TotalAmt |
| Program Services | $7,884,956 | ProgramServicesAmt |
| Management And General | $698,767 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $189,215 | TotalAmt |
| Program Services | $132,908 | ProgramServicesAmt |
| Management And General | $56,307 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $942,194 | TotalAmt |
| Program Services | $666,137 | ProgramServicesAmt |
| Management And General | $276,057 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $639,231 | TotalAmt |
| Program Services | $543,778 | ProgramServicesAmt |
| Management And General | $95,453 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,228 | TotalAmt |
| Management And General | $5,228 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,786 | TotalAmt |
| Management And General | $82,786 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,257,538 | TotalAmt |
| Program Services | $4,267,250 | ProgramServicesAmt |
| Management And General | $990,288 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,754 | TotalAmt |
| Program Services | $976 | ProgramServicesAmt |
| Management And General | $47,778 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $263,987 | TotalAmt |
| Program Services | $54,858 | ProgramServicesAmt |
| Management And General | $209,129 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,877 | TotalAmt |
| Program Services | $1,877 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $541,258 | TotalAmt |
| Program Services | $533,721 | ProgramServicesAmt |
| Management And General | $7,537 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,541 | TotalAmt |
| Program Services | $39,137 | ProgramServicesAmt |
| Management And General | $76,404 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,282 | TotalAmt |
| Program Services | $27,902 | ProgramServicesAmt |
| Management And General | $23,380 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,181,851 | TotalAmt |
| Program Services | $1,084,067 | ProgramServicesAmt |
| Management And General | $97,784 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,168,265 | TotalAmt |
| Program Services | $5,743,557 | ProgramServicesAmt |
| Management And General | $424,708 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $170,953 | TotalAmt |
| Program Services | $82,913 | ProgramServicesAmt |
| Management And General | $88,040 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT & COLLECTION | $3,355,170 | $3,355,170 | |
| PROGRAM SUPPLIES | $1,651,124 | $1,569,432 | $81,692 |
| EQUIPMENT RENTAL & MAIN | $372,308 | $110,251 | $262,057 |
| DUES AND SUBSCRIPTIONS | $70,061 | $21,193 | $48,868 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $217,024 | TotalAmt |
| Program Services | $50,070 | ProgramServicesAmt |
| Management And General | $166,954 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,815,526 | TotalAmt |
| Program Services | $26,170,203 | ProgramServicesAmt |
| Management And General | $4,645,323 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,180 | BOYAmt |
| EOY | $35,381 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $594,982 | BOYAmt |
| EOY | $1,421,268 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,412,648 | BOYAmt |
| EOY | $10,546,776 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,136,591 | BOYAmt |
| EOY | $4,513,060 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,188 | BOYAmt |
| EOY | $238,161 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $135,593 | BOYAmt |
| EOY | $133,582 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $110,913,993 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $18,940,809 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $87,093,691 | BOYAmt |
| EOY | $91,973,184 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $200,000 | BOYAmt |
| EOY | $200,000 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,500,907 | BOYAmt |
| EOY | $6,895,907 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $112,115,780 | BOYAmt |
| EOY | $115,957,319 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,040,831 | BOYAmt |
| EOY | $4,088,040 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,938 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $270,663 | BOYAmt |
| EOY | $420,984 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $64,332,322 | BOYAmt |
| EOY | $74,236,211 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $117,517 | BOYAmt |
| EOY | $117,517 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $71,789,271 | BOYAmt |
| EOY | $78,862,752 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,549,166 | BOYAmt |
| EOY | $24,590,469 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,777,343 | BOYAmt |
| EOY | $12,504,098 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,326,509 | BOYAmt |
| EOY | $37,094,567 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $112,115,780 | BOYAmt |
| EOY | $115,957,319 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$3,231,942 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $2,570 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,570 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS A MEMBER OF NORTH DAKOTA HOSPITAL ASSOCIATION AND NORTH DAKOTA LONG TERM CARE ASSOCIATION. A PORTION OF MEMBERSHIP DUES TO THE ABOVE LISTED ASSOCIATIONS IS USED FOR LOBBYING. THESE ASSOCIATIONS ADVOCATE ON BEHALF OF ITS MEMBERS FOR IMPROVING EFFICIENCY AND ACCESSIBILITY OF THE HEALTHCARE DELIVERY SYSTEMS AND THE HEALTH STATUS OF NORTH DAKOTA'S POPULATION. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,144,947 | OtherCostOrOtherBasisAmt |
| Book Value | $1,144,947 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $64,307,723 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,706,875 | DepreciationAmt |
| Book Value | $55,600,848 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $45,428,782 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,233,934 | DepreciationAmt |
| Book Value | $35,194,848 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $32,541 | OtherCostOrOtherBasisAmt |
| Book Value | $32,541 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $91,973,184 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| ASSETS RESTRICTED AS TO USE | $6,551,812 |
| CASH SURRENDER VALUE OF LIFE INSURANCE | $344,095 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $6,895,907 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO RELATED PARTY | Desc |
| Amt | $117,517 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $117,517 | TotalLiabilityAmt |
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 | 175.000000000000 | 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 | 248.000000000000 | 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 | $117,959 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $117,959 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00430 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,025,289 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,600,718 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,143,248 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,600,718 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $117,959 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00430 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $52,517 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $52,517 | DirectOffsettingRevenueAmt |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,917 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,917 | DirectOffsettingRevenueAmt |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,061,945 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,005,798 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,056,147 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03850 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,129,379 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,073,232 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,056,147 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03850 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,272,627 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,673,950 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,174,106 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04280 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $34,203 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $34,203 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $34,203 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $34,203 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,368,591 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $5,279,544 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,185,128 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $94,416 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE COUNTY HEALTHCARE SYSTEMS INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 709 4TH AVE NE | AddressLine1Txt |
| City | WATFORD CITY | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58854 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTP://MCKENZIEHEALTH.COM/ | WebsiteAddressTxt |
| State License | 5051A | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Emergency Room Other | Yes (X) | EmergencyRoomOtherInd |
| Other | SWING BED UNIT | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE COUNTY HEALTHCARE SYSTEMS INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 18 | 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 SUPPLEMENTAL INFORMATION | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE SUPPLEMENTAL INFORMATION | 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 | 175.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 248.000000000000 | 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 |
| 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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE SUPPLEMENTAL INFORMATION | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE SUPPLEMENTAL INFORMATION | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE SUPPLEMENTAL INFORMATION | 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 Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| MCKENZIE COUNTY HEALTHCARE SYSTEMS INC | PART V, SECTION B, LINE 5: APPROXIMATELY 350 PRINTED SURVEYS WERE DISTRIBUTED TO AREA RESIDENTS THROUGH VARIOUS CHANNELS THROUGHOUT THE COMMUNITY. 54 SURVEYS WERE RETURNED AND THE HOSPITAL IDENTIFIED SOME INFORMATION GAPS BASED ON THE DEMOGRAPHIC INFORMATION FROM THE SURVEYS RETURNED COMPARED TO TOTAL DEMOGRAPHIC INFORMATION. THEN INFORMATION INTERVIEWS WERE CONDUCTED. INTERVIEWS WERE 2 HOURS LONG AND CONDUCTED WITH 12 MEMBERS CHOSEN FROM THE COMMUNITY. INCLUDED AMONG THOSE INTERVIEWED WAS A PUBLIC HEALTH NURSE, PUBLIC SERVANTS, SCHOOL ADMINISTRATORS, THE COUNTY SHERIFF, BUSINESS PERSONS AND HEALTHCARE ADMINISTRATORS. |
| MCKENZIE COUNTY HEALTHCARE SYSTEMS INC | PART V, SECTION B, LINE 11: THE THREE MAIN AREAS OF CONCERN BROUGHT TO OUR ATTENTION DURING THE LAST CHNA REPORT IN 2019 HIGHLIGHTED: HOUSING, DOMESTIC ABUSE, AND HEALTHCARE STAFFING. MCHS CONTINUES TO ACTIVELY WORK WITH COMMUNITY AND CITY LEADERS ON HOUSING OPTIONS AND POTENTIAL PLANNING TO INCREASE THE AVAILABILITY OF SINGLE FAMILY HOUSING IN OUR COUNTY. THIS INVOLVEMENT IS BOTH VERBAL AS WELL AS THROUGH ACTIVE INVOLVEMENT IN COMMITTEES, SURVEYS, AND MISC. ENGAGEMENTS ASKED OF US BY CIVIC LEADERSHIP. AS OF EARLY 2019 AND ESTIMATED TO BE COMPLETED BY THE BEGINNING OF 2020, MCHS IS DEVELOPING LASTING RELATIONSHIPS WITH LOCAL HEALTH RESOURCES, SPECIFICALLY THOSE ADDRESSING DOMESTIC ABUSE AND VIOLENCE IN THE HOME. BY FACILITATING THESE ARRANGEMENTS MCHS AND ITS PARTNERSHIPS HOPE TO INCREASE LOCAL ACCESS AND AWARENESS OF DOMESTIC VIOLENCE MATERIAL THROUGH REFERRAL SOURCES, ONLINE EDUCATION, AND EDUCATIONAL BROCHURES TO BE LOCATED THROUGHOUT OUR HEALTHCARE FACILITY WHILE SIMULTANEOUSLY OFFERING DISCREET PACKAGING OF SUCH MATERIAL AND A PROFOUND SUPPORT AMONGST STAFF TO OFFER RESOURCES TO THOSE IN NEED. LASTLY, MCHS CONTINUES TO PUSH TOWARDS ITS RECRUITMENT OF EMPLOYED STAFF, SPECIFICALLY NURSING STAFF. A GOAL OF THE CHNA REPORT WAS TO EMPLOY AT LEAST 25% OF OUR OWN NURSING STAFF TO LESSEN OUR NEED TO LEAN ON TEMPORARY OR LONG TERM STAFFING ORGANIZATIONS. BY HIGHLIGHTING OUR EMPLOYMENT BENEFITS, ENRICHING OUR ORGANIZATIONAL CULTURE, STAYING COMPETITIVE, AND WORKING WITH THE COUNTY TO PROVIDE MORE HOUSING, WE ARE CONFIDENT THAT THE CONTINUED GROWTH OF MCHS WILL BE SUPPORTED BY OUR OWN, EMPLOYED, STAFF. |
| MCKENZIE COUNTY HEALTHCARE SYSTEMS INC | PART V, SECTION B, LINE 16J: IN ADDITION TO PROVIDING THE FULL POLICY UPON REQUEST, A SUMMARY OF THE POLICY IS POSTED IN THE EMERGENCY ROOMS, WAITING ROOMS, AND ADMISSIONS OFFICE. UPON ADMISSION THE PATIENTS RECEIVE A BROCHURE IN A PACKET REFERENCING THE FINANCIAL ASSISTANCE POLICY. THE PATIENTS ALSO RECEIVE INFORMATION IN THEIR FIRST BILLING INVOICE REGARDING THE FINANCIAL ASSISTANCE POLICY.FAP WEBSITE:HTTPS://WWW.MCKENZIEHEALTH.COM/WP-CONTENT/UPLOADS/2019/12/2019-2020-FINANCIAL-ASSISTANCE-POLICY-AND-PROCEDURE.PDFFAP APPLICATION WEBSITE:HTTPS://WWW.MCKENZIEHEALTH.COM/WP-CONTENT/UPLOADS/2018/01/2018-FINANCIAL-ASSISTANCE-APPLICATION.PDFFAP PLAIN LANGUAGE:HTTPS://WWW.MCKENZIEHEALTH.COM/WP-CONTENT/UPLOADS/2018/05/UPDATED-PLAIN-LANGUAGE-05.07.18.PDF |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - MCKENZIE COUNTY CLINIC | ||||
| 709 4TH AVE NE | WATFORD CITY | ND | 58854 | RURAL HEALTH CLINIC |
| 2 - GOOD SHEPHERD HOME | ||||
| 709 4TH AVE NE | WATFORD CITY | ND | 58854 | LT CARE & BASIC CARE |
| 3 - CONNIE WOLD WELLNESS CENTER | ||||
| 200 8TH ST NE | WATFORD CITY | ND | 58854 | WELLNESS CENTER |
| 4 - HORIZONS | ||||
| 705 4TH AVE NE | WATFORD CITY | NE | 58854 | ASSISTED LIVING COMPLEX |
| 5 - HERITAGE MANOR | ||||
| 709 4TH AVE NE | WATFORD CITY | NE | 58854 | APARTMENT COMPLEX |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE ORGANIZATION UTILIZES THEIR COST REPORT TO DETERMINE THE COST-TO-CHARGE RATIO. THE COST REPORT IS BASED OFF OF THE INTERNAL REPORTING SYSTEM USED BY THE ORGANIZATION. |
| PART I, LINE 7G: | THE ORGANIZATION INCLUDED THE OPERATIONS OF THEIR SKILLED NURSING FACILITY IN THE SUBSIDIZED SERVICES CALCULATION. |
| 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 $ 3,355,170. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | N/A |
| PART III, LINE 2: | THIS AMOUNT IS CALCULATED BY MULTIPLYING THE TOTAL CHARGES FOR SERVICES WRITTEN OFF AS BAD DEBT BY THE COST TO CHARGE RATIO. |
| PART III, LINE 3: | THE ORGANIZATION IS DILIGENT TO EVALUATE EACH PATIENTS ABILITY TO PAY AND DISTINGUISH BETWEEN BAD DEBT AND CHARITY CARE. |
| PART III, LINE 4: | PATIENT AND RESIDENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, WHICH REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT AND RESIDENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FOR UNINSURED PATIENTS AND AMOUNTS PATIENTS AND RESIDENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, THE HEALTH SYSTEMS ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. |
| PART III, LINE 9B: | THE ORGANIZATION DOES NOT COLLECT ON ACCOUNTS THAT HAVE A FINANCIAL ASSISTANCE APPLICATION IN REVIEW OR THAT HAS BEEN APPROVED. IF THE ACCOUNT IS NOT COMPLETELY WRITTEN OFF (BASED ON THE SLIDING FEE SCHEDULE) AND THEY DO NOT FOLLOW THROUGH ON THEIR PAYMENT PLAN FOR THE BALANCE, THAT WOULD BE THE ONLY TIME THE ACCOUNT WAS OUTSOURCED TO COLLECTIONS. |
| PART VI, LINE 2: | SEPARATE EVALUATIONS ARE COMPLETED ANNUALLY FOR THE CRITICAL ACCESS HOSPITAL AND THE RURAL HEALTH CLINIC. AT THIS TIME SERVICES AND STATISTICS ARE REVIEWED. EACH REPORT IS PRESENTED TO THE MEDICAL STAFF MEMBERS AND BOARD OF DIRECTORS. CURRENT SERVICES ARE DISCUSSED ALONG WITH THE NEEDS NOT CURRENTLY BEING MET. MANAGERS OF EACH DEPARTMENT ANNUALLY REVIEW THEIR SERVICES WITH THE BUDGETING PROCESS AND DISCUSS POSSIBLE PROJECTION OF NEW SERVICES. ONCE A NEED IS DETERMINED, IT IS DISCUSSED ON A DEPARTMENTAL LEVEL, INFORMATION IS GATHERED AND PRESENTED TO THE CEO/CFO FOR APPROVAL. MCHS HOLDS THEIR ANNUAL MEETING FOR THE PUBLIC IN THE FALL OF EACH CALENDAR YEAR. THIS IS AN OPEN MEETING ALLOWING THE PUBLIC TO VOICE CONCERNS AND SUGGESTIONS. |
| PART VI, LINE 3: | THE MCHS CHARITY CARE POLICY IS POSTED IN THE HOSPITAL AND CLINIC ADMISSIONS AREAS AND EMERGENCY ROOM. COPIES OF THE POLICY AND APPLICATIONS ARE AVAILABLE IN EACH RECEPTION AREA OF THE HOSPITAL AND CLINIC. INFORMATION IS SENT OUT TO ALL PATIENTS WITH THEIR FIRST STATEMENT. IF A BILL IS UNPAID, AFTER TWO STATEMENTS HAVE BEEN SENT, A BILLING EMPLOYEE WILL ATTEMPT TO REACH THE RESPONSIBLE PARTY BY PHONE TO DISCUSS INSTALLMENT PLANS, CHARITY CARE, AND/OR DISCUSS VARIOUS GOVERNMENT BENEFITS SUCH AS MEDICAID. THE MCHS BUSINESS OFFICES ALSO HAVE THE APPLICATIONS AT ALL TIMES. THE BUSINESS OFFICE STAFF COUNSEL ANYONE WHO PRESENTS THEMSELVES WITH OVERDUE BALANCES AND PRESENT THE ABOVE OPTIONS. |
| PART VI, LINE 4: | MCKENZIE COUNTY HEALTHCARE SERVICES SERVES MCKENZIE COUNTY. MCKENZIE COUNTY IS THE LARGEST COUNTY IN THE STATE OF NORTH DAKOTA. IT IS VERY RURAL AND INCLUDES PART OF THE FORT BERTHOLD RESERVATION. MCKENZIE COUNTY HOSPITAL IS THE ONLY HEALTHCARE SYSTEM WITHIN A 45 MILE RADIUS. THE COUNTY'S POPULATION WAS ESTIMATED IN 2010 AT 6,380. THE MEDIAN HOUSEHOLD INCOME IN 2010 WAS REPORTED AT $48,480. 100% OF THE POPULATION WAS REPORTED BELOW THE POVERTY LEVEL IN 2010. THE RUGGED TERRAIN, WINTER CONDITIONS, INCREASED OIL ACTIVITY, AND RECREATIONAL ACTIVITIES HAVE ALL ADDED TO THE INCREASED NUMBER OF EMERGENCY ROOM VISITS. WITH THE RECENT OIL ACTIVITY IN THE STATE, MCKENZIE COUNTY IS EXPERIENCING A RAPID INCREASE IN POPULATION, NEW BUSINESSES, HOUSING PROJECTS, AND IMPROVED WAGE SCALES. WITH THIS RAPID GROWTH, MCHS IS EXPERIENCING AN INFLUX IN EMERGENCY ROOM SERVICES, SHORTAGE OF PHYSICIANS AND NURSES, AS WELL AS GROWING BAD DEBT EXPENSES RELATED TO MEDICAL SERVICES PROVIDED TO UNINSURED WORKERS AND PATIENTS THAT DO NOT HAVE A PERMANENT RESIDENCE TO SEND BILLS TO. |
| PART VI, LINE 5: | THE MCKENZIE COUNTY BOARD OF DIRECTORS IS MADE UP OF VOLUNTEER MEMBERS FROM THE LOCAL COMMUNITY OF WATFORD CITY AND THE SURROUNDING AREAS. MCHS DOES EXTEND PRIVILEGES TO ALL PHYSICIANS IN THE AREA. SPECIALISTS WILL ALSO VISIT THE LOCAL HOSPITAL AND CLINIC TO EXPAND THE PRESENT SERVICES. SURPLUS FUNDS ARE APPLIED FOR THE PURPOSES EDUCATION, INCREASING PATIENT SERVICES, WELLNESS, AND PREVENTATIVE CARE TO ITS CLIENTS. MCHS IS ALSO A PART OF A WORKSITE WELLNESS NORTH DAKOTA PROGRAM. IT ALLOWS THEIR CARDIAC WELLNESS MANAGER (RN) TO WORK CLOSELY IN THE STATE-WIDE PROGRAM THAT CAN GREATLY IMPROVE THE HEALTH OF EMPLOYEES, RESULTING IN LOWER HEALTH CARE COSTS, AND INCREASED PRODUCTIVITY AND MORALE. MCKENZIE COUNTY HEALTHCARE SYSTEMS AND THE MCKENZIE COUNTY HEALTHCARE SYSTEMS BENEFIT FUND TOGETHER ENGAGED IN THE BUILDING AND FUNDING OF A NEW WELLNESS CENTER. THE WELLNESS CENTER OPENED IN MARCH 2013. THE WELLNESS CENTER HOUSES A NEW PHYSICAL THERAPY DEPARTMENT TO BETTER UTILIZE A THERAPY POOL AND HAS INCREASED THE PRESENT SQUARE FOOTAGE OF THE HOSPITAL. PREVENTION IS A KEY WORD TODAY. THE WELLNESS CENTER PROVIDES EDUCATION AND EXERCISE TO ITS MEMBERS. IT WILL HELP IMPROVE OR PREVENT DISEASES LIKE DIABETES, HIGH BLOOD PRESSURE, OBESITY, DEPRESSION, AND MANY NOT LISTED. IN AN EFFORT TO ENHANCE SERVICES IN THE RURAL AREAS, MCKENZIE COUNTY HEALTHCARE PARTICIPATES IN SEVERAL PROGRAMS. THE RURAL ACCOUNTABLE CARE ORGANIZATION IS INTENDED TO BETTER SERVE OUR POPULATION BY IMPROVING HEALTHCARE, PATIENT SATISFACTION, AND REDUCING COSTS WHILE IMPROVING FINANCIAL PERFORMANCE AND SUSTAINABILITY. THE FRONTIER COMMUNITY HEALTHCARE INTEGRATION PROJECT (FCHIP) IS A DEMONSTRATION PROGRAM THAT ASSISTS OUR ORGANIZATION WITH PROVIDING TELEMEDICINE SERVICES TO OUR POPULATION IN ORDER TO PROVIDE ACCESS TO MORE SPECIALTY SERVICES TO THE RESIDENTS OF OUR COMMUNITIES. THESE PROGRAMS ARE AIMED AT INCREASING THE INTEGRATION AND COORDINATION OF CARE AMONGST PROVIDERS AND IMPROVE THE OVERALL QUALITY OF CARE FOR OUR HEALTHCARE COMMUNITY. |
| PART VI, LINE 6: | N/A |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| 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 (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DANIEL KELLY | ||||||||||||||
| CEO | $495,748 | $0 | $0 | $0 | $0 | $0 | $20,943 | $0 | $1,250 | $0 | $517,941 | $0 | $0 | $0 |
| DR GARY RAMAGE | ||||||||||||||
| PHYSICIAN | $343,420 | $0 | $0 | $0 | $0 | $0 | $13,556 | $0 | $3,992 | $0 | $360,968 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | $92,500 WAS CONTRIBUTED TO A 457(F) PLAN FOR DANIEL KELLY. | ExplanationTxt |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DANIEL KELLY | PersonNm |
| Relationship With Org | CEO | RelationshipWithOrgTxt |
| Loan Purpose | SPLIT DOLLAR LIFE INSURANCE POLICY | LoanPurposeTxt |
| Loan To Organization | Yes (X) | LoanToOrganizationInd |
| Original Principal | $92,500 | OriginalPrincipalAmt |
| Balance Due | $420,984 | BalanceDueAmt |
| Default | 0 | DefaultInd |
| Board Or Committee Approval | Yes (1) | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (1) | WrittenAgreementInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $420,984 | TotalBalanceDueAmt |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| LESLIE KELLY | |||
| SPOUSE OF CEO | $53,412 | EMPLOYEE SALARY | 0 |
| SAMUEL KELLY | |||
| SON OF CEO | $75,584 | EMPLOYEE SALARY | 0 |
| DANIELLE KELLY | |||
| DAUGHTER OF CEO | $23,855 | EMPLOYEE SALARY | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | MICHAEL CURTIS AND SUSIE CURTIS HAVE A FAMILY RELATIONSHIP. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE MCHS CEO AND CFO REVIEW AND APPROVE THE FORM 990. THE BOARD OF DIRECTORS RECEIVE A COPY OF THE FINAL FORM 990 BEFORE IT IS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | AN INTERESTED PERSON IS DEFINED AS ANY DIRECTOR, PRINCIPAL OFFICER, AND ANYONE WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST WITH RESPECT TO ALL ENTITIES IN THE HEALTHCARE SYSTEM. AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND WILL BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS. THE CONFLICT WILL BE REVIEWED BY THE REMAINING BOARD AND WILL DETERMINE IF A CONFLICT EXISTS. IF A CONFLICT EXISTS, THE INTERESTED PERSON MUST ABSTAIN FROM VOTING ON THE ISSUE AND THE REMAINING BOARD MEMBERS WILL DETERMINE IF THE TRANSACTION IS IN THE HOSPITAL'S BEST INTEREST, FOR ITS OWN BENEFIT, AND IF IT IS FAIR AND REASONABLE. THIS IS ACCOMPLISHED THROUGH ANNUAL REVIEW AND A SIGNED STATEMENT STATING THAT THE INTERESTED PERSON HAS OBTAINED A COPY OF THE POLICY AND HAS READ AND UNDERSTANDS THE POLICY, AND HAS AGREED TO COMPLY WITH THE POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15 | MEMBERS OF THE BOARD OF TRUSTEES REVIEW STATE-WIDE SALARY SURVEY INFORMATION AND OTHER FORM 990'S WHEN DETERMINING ANY WAGE CHANGES. THE CEO HAS AN ANNUAL EVALUATION COMPLETED EACH YEAR. THE CEO HAS THE OPPORTUNITY TO GIVE A PROPOSAL TO THE BOARD AT HIS EVALUATION. ANY CHANGE OR REVISION IS RECORDED IN THE BOARD MINUTES. AN ADDENDUM TO THE TERMS OF EMPLOYMENT IS SIGNED BY THE BOARD PRESIDENT AND CEO FOR THE PERSONNEL FILE. THE CEO APPROVES THE CFO COMPENSATION BASED UPON SURVEY DATA ON AN ANNUAL BASIS. THE RESULTS ARE DOCUMENTED IN THE CFO'S ANNUAL EVALUATION PAPERWORK. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | EMERGENCY ROOM PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,183,891. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,183,891. CLINIC MD PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 945,538. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 945,538. NURSING HOME PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 237,741. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 237,741. OTHER CONTRACTOR SERVICES: PROGRAM SERVICE EXPENSES 1,157,300. MANAGEMENT AND GENERAL EXPENSES 990,288. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,147,588. ADULTS AND PEDS SERVICES: PROGRAM SERVICE EXPENSES 742,780. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 742,780. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE COUNTY HEALTHCARE SYSTEMS PROPERTIES | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 709 4TH AVE NE | AddressLine1Txt |
| City | WATFORD CITY | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58854 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 462905447 | EIN |
| Primary Activities | PROPERTY MANAGEMENT | PrimaryActivitiesTxt |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Total Income | $35,336 | TotalIncomeAmt |
| End Of Year Assets | $683,274 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE COUNTY HEALTHCARE SYSTEMS INC | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE BENEFIT FUND OF MCKENZIE COUNTY HEALTHCARE SYSTEMS INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 709 4TH AVE NE | AddressLine1Txt |
| City | WATFORD CITY | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58854 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363431210 | EIN |
| Primary Activities | TO SUPPORT THE MCKENZIE COUNTY HEALTHCARE SYSTEMS | PrimaryActivitiesTxt |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 7 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCKENZIE COUNTY HEALTHCARE SYSTEMS INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| 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 | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| THE BENEFIT FUND OF MCKENZIE COUNTY HEALTHCARE SYSTEMS INC | ||
| C | $1,875,001 | ACTUAL |
| THE BENEFIT FUND OF MCKENZIE COUNTY HEALTHCARE SYSTEMS INC | ||
| E | $117,517 | ACTUAL |