2020-11-04T11:33:01-06:00 2020-03-31 450310328 BRADY MARTZ AND ASSOCIATES PC PO BOX 14296 GRAND FORKS ND 582084296 990 2019-04-01 450253272 LINTON HOSPITAL LINT 7012544511 518 N BROADWAY STREET LINTON ND 585520850 SANDRA MEIDINGER PRESIDENT 7012544511 2020-10-30 1 NICOLE HELDSTAB P01220683 7017754685 2020-10-29 24.111.23.187 2020-10-30 13:06:10 CD P 1A886B36530094DB920E7B1751272D2D2635940B 6C39C89A0B916563EEFC9C4D81EC75D1023FE21F 2019 2021-01-29 14:40:06Z SANDRA MEIDINGER 518 N BROADWAY STREET LINTON ND 585520850 9618532 0 X WWW.LINTONHOSPITAL.ORG X 1953 ND LINTON HOSPITAL IS A 14-BED CRITICAL ACCESS HOSPITAL THAT OPERATES A 24-HOUR ACUTE AND EMERGENCY FACILITY IN THE TOWN OF LINTON, EMMONS COUNTY, NORTH DAKOTA. LINTON HOSPITAL ALSO OWNS AND OPERATES 3 CLINICS (2 RURAL HEALTH) IN THE COMMUNITIES OF LINTON AND HAZELTON, NORTH DAKOTA AND HERREID, SOUTH DAKOTA. LINTON HOSPITAL ENTERED INTO A MANAGEMENT SERVICES AGREEMENT ON 6/1/2012 WITH CHI ST. ALEXIUS HOSPITAL OF BISMARCK TO IMPROVE THE QUALITY AND PRODUCTIVITY OF RURAL HEALTH CARE, PROMOTE COST-EFFICIENT OPERATIONS AND ENHANCE THE COMPETITIVE ASPECTS OF THE DELIVERY OF RURAL HEALTH CARE SERVICES TO THE COMMUNITY OF LINTON AND THE GEOGRAPHIC REGIONS SERVED BY LINTON. 7 7 107 0 0 0 399387 389681 8173298 9177627 11870 26645 13002 21025 8597557 9614978 0 0 0 0 4600892 4965296 0 0 60371 3769330 4251075 8370222 9216371 227335 398607 5403111 5676257 1191842 1066381 4211269 4609876 X THE MISSION OF LINTON HOSPITAL AND CLINICS IS TO ENHANCE THE HEALTH, WELL-BEING, AND QUALITY OF LIFE OF THE PEOPLE WE SERVE. 0 0 6375484 6345784 LINTON HOSPITAL IS A 14-BED CRITICAL ACCESS HOSPITAL THAT HAS AVAILABLE 24-HOUR LICENSED HEALTHCARE PRACTITIONERS AND NURSING SERVICES. SWINGBED SERVICES ARE AVAILABLE FOR PATIENTS REQUIRING SKILLED CARE. EMERGENCY ROOM CARE IS PROVIDED TO OVER 1,100 EMERGENCY ROOM VISITS PER YEAR. LINTON HOSPITAL ALSO PROVIDES THE FOLLOWING SERVICES: OPERATING ROOM, ANESTHESIA SERVICES, DIETARY SERVICES, MEDICAL RECORDS SERVICES, PHARMACEUTICAL SERVICES, LABORATORY SERVICES, HOUSEKEEPING, ELECTROCARDIOGRAMS, SLEEP STUDIES, CARDIAC REHAB, PHYSICAL THERAPY, ULTRASOUND SERVICES, RADIOLOGY, DIGITAL MAMMOGRAM SERVICES, CARDIAC STRESS TESTS, MRI SERVICES, CT SCAN AND DIABETIC EDUCATION SERVICES. THE ORGANIZATION PROVIDES THESE SERVICES THROUGH PARTICIPATION IN THE GOVERNMENT PROGRAMS SUCH AS CMS. LINTON HOSPITAL'S COMMUNITY CARING PROGRAM (CHARITY CARE) POLICY PROVIDES DISCOUNTED OR FREE SERVICES TO PATIENTS WHO QUALIFY. THIS POLICY IS DESIGNED TO ENSURE THAT THE COMMUNITIES SERVED HAVE ACCESS TO NEEDED HEALTHCARE. 1257167 1940519 LINTON HOSPITAL OWNS AND OPERATES 3 CLINICS IN THE CITIES OF LINTON AND HAZELTON, ND AND HERREID, SD. TWO OF THESE CLINICS ARE DESIGNATED RURAL HEALTH CLINICS AND THE HAZELTON CLINIC IS A FREE-STANDING CLINIC. LINTON HOSPITAL EMPLOYS ONE FAMILY PRACTICE PHYSICIAN, THREE NURSE PRACTITIONERS, AND ONE PHYSICIAN ASSISTANT TO PROVIDE SERVICES TO THE HOSPITAL AND CLINICS. TOTAL CLINIC VISITS WERE 7,822 THIS YEAR. THE ORGANIZATION PROVIDES THESE SERVICES THROUGH PARTICIPATION IN GOVERNMENT PROGRAMS SUCH AS CMS. LINTON HOSPITAL'S COMMUNITY CARE PROGRAM POLICY PROVIDES DISCOUNTED OR FREE SERVICES TO PATIENTS WHO QUALIFY. THIS POLICY IS DESIGNED TO ENSURE THAT COMMUNITIES SERVED HAVE ACCESS TO NEEDED HEALTHCARE. 282799 820823 LINTON HOSPITAL OPERATES THE EMMONS COUNTY EMERGENCY AMBULANCE SERVICE (INCLUDING FOOT CARE) WHICH COVERS A SERVICE AREA OF 1,555 SQUARE MILES. EMMONS COUNTY IS SURROUNDED BY KIDDER, LOGAN, AND MCINTOSH COUNTIES IN NORTH DAKOTA AND CAMPBELL COUNTY IN SOUTH DAKOTA. THE EMMONS COUNTY EMERGENCY AMBULANCE SERVICE PROVIDES 24 HOUR, 7 DAYS A WEEK ADVANCED LIFE SUPPORT SERVICE TO A POPULATION OF APPROXIMATELY 3,500 RESIDENTS. LINTON HOSPITAL PROVIDES THESE SERVICES THROUGH PARTICIPATION IN GOVERNMENT PROGRAMS SUCH AS CMS. THE ORGANIZATION'S COMMUNITY CARE POLICY PROVIDES DISCOUNTED OR FREE SERVICES TO PATIENTS WHO QUALIFY. THIS POLICY IS DESIGNED TO ENSURE THAT COMMUNITIES SERVED HAVE ACCESS TO NEEDED HEALTHCARE. 91526 OTHER REVENUE INCLUDES INCOME GENERATED FROM CONTRACTED PHYSICIANS, CAFETERIA SALES, SALE OF SUPPLIES AND RENTAL OF HOSPITAL SPACE. 91526 7915450 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 53 0 1 107 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X X ROBERT BLACK 7012544511 518 N BROADWAY STREET LINTON ND 585520850 JACKIE GRUNEFELDER NP 40.00 X 202333 0 8471 PAULA MOCH NP 40.00 X 140400 0 18113 RON KAISER PT MANAGER 40.00 X 111568 0 14787 LUKAS FISCHER CNO/ COO 40.00 X 97976 0 17769 JOSIE SENGER NP 40.00 X 109073 0 1626 SARAH NEWTON MD 40.00 X 106374 0 2294 DEREK SCHAFF CFO 40.00 X 66779 0 14146 SPENCER LARSON BOARD MEMBER 1.00 X 0 0 0 BRIAN SCHUMACHER BOARD MEMBER 1.00 X 0 0 0 TOM MITZEL BOARD MEMBER 1.00 X 0 0 0 LAURA JOCHIM BOARD MEMBER 1.00 X 0 0 0 TEMREE APPERT BOARD VICE PRESIDENT 1.00 X X 0 0 0 KELLIE HUIZENGA BOARD SECRETARY 1.00 X X 0 0 0 SANDRA MEIDINGER BOARD PRESIDENT 2.00 X X 0 0 0 ROBERT BLACK CEO - CONTRACTED 40.00 X 0 0 0 834503 0 77206 5 0 1 0 CHI ST ALEXIUS MEDICAL CENTER 900 E BROADWAY AVE BISMARCK ND 58501 ADMINISTRATIVE SERVICES 421086 NXC IMAGING 1325 QUINCY STREET NE SUITE A2 MINNEAPOLIS MN 55413 MEDICAL IMAGING SERVICES 202093 TECTA AMERICA DAKOTAS LLC 1810 N 6TH ST GRAND FORKS ND 58203 CONSTRUCTION 187865 AVERA ECARE 4500 N LEWIS AVE SIOUX FALLS SD 57104 E-EMERGENCY & E-PHARMACY SERVICES 131849 4 271944 117737 389681 PATIENT SERVICE REVENU 624100 7992289 7992289 340B PROGRAM 624100 1114837 1114837 SUPPLIES 624100 16676 16676 CONTRACTED PHYSICIANS 624100 9465 9465 CAFETERIA 624100 7432 7432 36928 36928 9177627 25070 25070 13080 3554 9526 9526 9526 1575 0 1575 1575 1575 MISCELLANEOUS 900099 11499 11499 11499 9614978 9198652 0 26645 216568 61946 154622 3748547 3398743 301924 47880 728757 661309 58140 9308 271424 239594 28647 3183 29187 29187 205281 169672 35609 22938 2972 19966 92473 92473 44545 36940 7605 4514 4514 520235 520235 61163 14241 46922 SUPPLIES 790609 686738 103871 CONTRACTED SERVICES 754159 549095 205064 340B EXPENSE 597287 597287 DRUGS & IV'S 345768 345768 782916 626396 156520 9216371 7915450 1240550 60371 707993 1025683 1139141 1127775 1627737 1429727 147675 181458 98923 109359 7361191 5558936 1681642 1802255 5403111 5676257 685119 667924 506723 398457 1191842 1066381 X 4077526 4609876 133743 0 4211269 4609876 5403111 5676257 398607 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 1794 1794 0 PART II-B, LINE 1: THE ORGANIZATION IS A MEMBER OF THE NORTH DAKOTA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, BOTH OF WHICH HAVE LOBBYING EXPENSES. ORGANIZATION OFFICERS AND DIRECTORS WILL ALSO FROM TIME TO TIME CONTACT LEGISLATORS CONCERNING HEALTH CARE ISSUES AND BILLS. 71911 71911 2885448 2151719 733729 4403832 3407217 996615 1802255 X PART X, LINE 2: LINTON HOSPITAL AND LINTON HOSPITAL FOUNDATION ARE NORTH DAKOTA NONPROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THEREFORE, THE HOSPITAL AND FOUNDATION ARE NOT SUBJECT TO FEDERAL INCOME TAXES. THE HOSPITAL'S POLICY IS TO EVALUATE THE LIKELIHOOD THAT ITS UNCERTAIN TAX POSITIONS WILL PREVAIL UPON EXAMINATION BASED ON THE EXTENT TO WHICH THOSE POSITIONS HAVE SUBSTANTIAL SUPPORT WITHIN THE INTERNAL REVENUE CODE AND REGULATIONS, REVENUE RULINGS, COURT DECISIONS, AND OTHER EVIDENCE. IT IS THE OPINION OF MANAGEMENT THAT THE HOSPITAL HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION. THE INCOME TAX RETURNS OF THE HOSPITAL ARE SUBJECT TO EXAMINATION BY THE IRS AND STATE TAX AUTHORITIES, GENERALLY FOR THREE YEARS AFTER THEY WERE FILED, ALL FILINGS ARE CURRENT. 1 1 X 1 X 1 X 1 0 0 6389 6389 0.00070 6389 6389 0.00070 6389 6389 0.00070 1 66682 6668 4338775 4338775 X 1 1 4 1 LINTON HOSPITAL 518 NORTH BROADWAY LINTON ND 585520850 X CRITICAL ACCESS HOSPITAL AND SWINGBED A 2 LINTON MEDICAL CENTER 511 ELM STREET LINTON ND 58552 X RURAL HEALTH CLINIC A 3 HAZELTON CLINIC 343 MAIN STREET HAZELTON ND 58544 X CLINIC - PROVIDER BASED A 4 CAMPBELL COUNTY CLINIC - HERREID 208 MAIN STREET NORTH HERREID SD 57632 X RURAL HEALTH CLINIC A LINTON HOSPITAL 0 0 1 X X X X X X X X X 17 1 0 1 1 X WWW.LINTONHOSPITAL.ORG X 1 17 1 WWW.LINTONHOSPITAL.ORG 0 1 X 100.000000000000 200.000000000000 X X 1 1 X X X X 1 X WWW.LINTONHOSPITAL.ORG X 1 X 0 1 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: LINTON HOSPITAL, - FACILITY 2: LINTON MEDICAL CENTER, - FACILITY 3: HAZELTON CLINIC, - FACILITY 4: CAMPBELL COUNTY CLINIC - HERREID LINTON HOSPITAL PART V, SECTION B, LINE 5: CENTER FOR RURAL HEALTH OF NORTH DAKOTA CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT FOR LINTON HOSPITAL AND CLINICS. WE DEVELOPED A COMMITTEE TO ADDRESS THE PRIORITY CONCERNS ADDRESSED IN THE REPORT AND INCLUDED THE EMMONS COUNTY PUBLIC HEALTH DEPT. OUR NURSE PRACTITIONER HAS PROVIDED HEALTHCARE IN-SERVICE TO THE LOCAL SENIOR CITIZENS CENTER ON THE TOPICS OF DIABETES, OBESITY, AND HEART DISEASE. WE HAVE PROVIDED FREE BLOOD PRESSURE AND DIABETIC SCREENINGS AT OUR HOSPITAL WEEK IN MAY, AS WELL AS PROVIDING A FREE TEDDY BEAR CLINIC FOR AWARENESS OF PEDIATRIC SERVICES. A FOCUS ON INCREASED STRATEGIC ADVERTISING HAS BEEN MADE TO ALERT OUR CUSTOMERS TO THE SERVICES THAT WE PROVIDE. LINTON HOSPITAL PART V, SECTION B, LINE 6B: CENTER FOR RURAL HEALTH AND EMMONS COUNTY PUBLIC HEALTH DEPARTMENT LINTON HOSPITAL PART V, SECTION B, LINE 11: THE HIGHEST PRIORITY OF THE CHNA IS TO ATTAIN AND RETAIN PRIMARY CARE PHYSICIANS. THE HOSPITAL RECENTLY RECRUITED A PHYSICIAN THAT STARTED IN JULY 2019. THE HOSPITAL IS ALSO WORKING WITH THE COMMUNITY ON THE SECOND PRIORITY, TO IMPLEMENT AND PROMOTE PROGRAMS AROUND HEALTHY LIFESTYLES AND WELLNESS. LIMITED RESOURCES ARE A CHALLENGE IN THE IMPLEMENTATION OF THE PRIORITIES. PART I, LINE 7: THE AMOUNTS WERE DETERMINED USING THE IRS RECOMMENDED WORKSHEET 1 - CHARITY CARE AT COST.PART I, LINE 7A: LINTON HOSPITAL HAD CUSTOMERS APPLY FOR UNCOMPENSATED CARE THROUGH THEIR COMMUNITY CARING PROGRAM WHICH DISCOUNTS OR WRITES OFF CHARGES BASED UPON THEIR INABILITY TO PAY. THE ACTUAL AMOUNT WRITTEN OFF WAS $7,479, AND BASED UPON OUR COST TO CHARGE RATIO DETERMINED FROM THE INTERIM COST REPORT FROM CMS, 85% WAS USED TO DETERMINE THE ACTUAL COST WRITTEN OFF. PART III, LINE 4: BAD DEBT EXPENSE IS CALCULATED USING THE ACCOUNTS RECEIVABLE AGING REPORT BASED UPON DISCHARGE DATES. THEREFORE, WE RECOGNIZE BALANCES LESS THAN 30 DAYS TO BE 5% UNCOLLECTIBLE AND THIS FORMULA GRADUALLY INCREASES IN 30 DAY INCREMENTS, REACHING A BALANCE EXCEEDING 180 DAYS TO BE 75% UNCOLLECTIBLE. THESE BALANCES ARE CALCULATED ON A MONTHLY BASIS. WE ESTIMATE APPROXIMATELY 10% OF THIS BALANCE TO BE ELIGIBLE TO CALCULATE LINE 3, PART III.SEE PAGES 11 AND 12 OF THE AUDIT REPORT FOR THE "PATIENT RECEIVABLES" FOOTNOTE. PART III, LINE 8: MEDICARE 8 COSTING METHODOLOGY USING THE MEDICARE COST REPORT, WHICH DOES REMOVE CERTAIN NON-ALLOWED MEDICARE COSTS. PART III, LINE 9B: THE FINANCIAL ASSISTANCE POLICY, ALSO KNOWN AS THE COMMUNITY CARING PROGRAM WAS UPDATED AND APPROVED BY THE HOSPITAL BOARD OF DIRECTORS IN 2015. THIS POLICY OUTLINES THE DEFINITIONS OF THE MEDICAL ELIGIBLE INDIGENCE AND PROVIDES THE CRITERIA AND PROCEDURES INVOLVED IN DETERMINING FINANCIAL ASSISTANCE. NOTICE OF THE COMMUNITY CARING PROGRAM IS PROVIDED ON ALL MONTHLY STATEMENTS TO ALL PATIENTS. THE ENTIRE POLICY IS POSTED ON THE HOSPITAL WEBSITE AND IS ALSO AVAILABLE UPON REQUEST. PART VI, LINE 2: TO HELP FILL THE NEEDS, THE HOSPITAL HAS ESTALISHED CLINICS IN FOUR RURAL COMMUNITIES TO BETTER PROVIDE SERVICES TO THE PUBLIC. PART VI, LINE 3: LINTON HOSPITAL AND CLINICS HAVE AN ASSISTANCE PROGRAM CALLED "COMMUNITY CARING," WHICH IS A CHARITY PROGRAM FOR PEOPLE WHO CANNOT AFFORD TO PAY FOR THEIR HEALTHCARE. A COMMITTEE COMPRISED OF THE CHIEF FINANCIAL OFFICER, HOSPITAL BUSINESS OFFICE MANAGER AND THE CLINIC BUSINESS MANAGERS REVIEW THE APPLICATIONS TO DETERMINE ELIGIBILITY. THE FINAL DETERMINATION IS FORWARDED TO THE CHIEF EXECUTIVE OFFICER FOR APPROVAL. THE GUARANTOR OR RESPONSIBLE PARTY IS NOTIFIED BY MAIL AND THE BALANCES ASSOCIATED WITH THIS PROGRAM ARE REPORTED TO THE GOVERNING BOARD OF DIRECTORS. THE APPLICATION PROCESS IS STATED ON THE BACK OF PATIENT STATEMENTS AND ON THE APPLICATION ITSELF. APPLICATIONS WILL BE AVAILABLE UPON REQUEST. A FILE WILL BE INITIATED ANYTIME THERE IS A REQUEST. A DOCUMENTATION FORM WILL BE FILLED OUT AND PLACED IN THE FILE. THE FILE WILL BE STORED IN THE BUSINESS OFFICE MANAGERS OFFICE AT THE LINTON HOSPITAL. PART VI, LINE 4: LINTON HOSPITAL IS A 14 BED CRITICAL CARE ACCESS HOSPITAL LOCATED IN EMMONS COUNTY IN SOUTH CENTRAL NORTH DAKOTA. LINTON HOSPITAL OWNS ONE RURAL HEALTH CLINIC AND OPERATES THREE CLINICS WITH AGREEMENTS OF THE COMMUNITIES WHERE THESE CLINICS ARE LOCATED. THESE HEALTHCARE FACILITIES ARE THE PRIMARY SOURCE OF HEALTHCARE FOR RESIDENTS IN THE COMMUNITIES OF LINTON, STRASBURG, AND HAGUE IN EMMONS COUNTY, ZEELAND IN MCINTOSH COUNTY, AND BRADDOCK, KINTYRE, AND NAPOLEON IN LOGAN COUNTY IN NORTH DAKOTA. THE COMMUNITY OF LINTON IS LOCATED APPROXIMATELY 25 MILES FROM THE SOUTH DAKOTA BORDER, SO WE PROVIDE HEALTHCARE TO RESIDENTS OF HERREID AND POLLOCK, CAMPBELL COUNTY, SOUTH DAKOTA AS WELL.LINTON HOSPITAL AND CLINICS HAVE BEEN PROVIDING HEALTHCARE TO THE RESIDENTS OF THE SERVICE AREA SINCE 1953. ACCORDING TO THE 2010 CENSUS, THE TOTAL POPULATION OF EMMONS COUNTY WAS 3,550. 27% OF THIS POPULATION WAS OVER THE AGE OF 65. CAMPBELL COUNTY, SD REPORTED A TOTAL POPULATION OF 1,441 WITH 25% OVER THE AGE OF 65.LINTON HOSPITAL IS LOCATED IN A DESIGNATED MEDICALLY UNDERSERVED AREA AND IN A HEALTH PROFESSIONAL SHORTAGE AREA IN NORTH DAKOTA. PART VI, LINE 5: LINTON HOSPITAL HOSTS A CUSTOMER APPRECIATION DAY, IN WHICH PEOPLE FROM THE ENTIRE SERVICE AREA ARE INVITED TO THE HOSPITAL CAMPUS FOR A COMPLIMENTARY MEAL. PROFESSIONAL STAFF ARE AVAILABLE TO MONITOR BLOOD SUGAR OF ALL PARTICIPANTS AT NO CHARGE. CLINICS IN HAZELTON, POLLOCK, AND HERREID PROVIDE BLOOD PRESSURE CHECKS AND ASSIST WITH ADMINISTRATION OF SELF-ADMINISTERED MEDICATIONS AT NO CHARGE.LINTON HOSPITAL EMPLOYS A RISK MANAGER AND BIOTERRISM COORDINATOR WHO MEET WITH THE LOCAL EMERGENCY PLANNING COMMITTEE AND ALSO PARTICIPATE IN THE EMMONS COUNTY MULTI-HAZARD MITIGATION PLAN FOR PREVENTION AND PLANNING FOR DISASTERS. LINTON HOSPITAL IS A MEMBER AND HAS AN EMPLOYEE WHO IS ACTIVELY INVOLVED WITH THE LINTON INDUSTRIAL DEVELOPMENT COMMITTEE. THE LINTON HOSPITAL ALSO OPERATES THE EMMONS COUNTY AMBULANCE SERVICE. THE DEPARTMENT RESPONDS TO FIRE CALLS, PROVIDES CPR TRAINING TO SCHOOL CHILDREN, IS ON STAND-BY AT LOCAL FOOTBALL GAMES AND COMMUNITY EVENTS AS A COURTESY TO THE COMMUNITY.THE LINTON HOSPITAL EMPLOYS A PART TIME COMMUNITY RESOURCE PERSON WHO IDENTIFIES INDIGENT CUSTOMERS AND ASSISTS THEM WITH APPLYING TO DRUG COMPANIES FOR FREE PRESCRIPTION DRUGS. THE ORGANIZATION ALSO EMPLOYS A REGISTERED NURSE WHO MANAGES A "DIABETIC MANAGEMENT" PROGRAM BY COUNSELING DIABETIC PATIENTS, PROVIDING FOOT CARE, AND MONITORING PATIENTS' PROGRESS WITH THEIR MEDICAL PROVIDER. PART VI, LINE 6: NOT APPLICABLE. X X X 0 0 0 0 0 0 0 0 0 JACKIE GRUNEFELDER NP 202333 0 0 0 0 0 8003 0 468 0 210804 0 0 0 PAULA MOCH NP 140400 0 0 0 0 0 4444 0 13669 0 158513 0 0 0 PART I, LINE 3 ROBERT BLACK, THE CEO / EXECUTIVE DIRECTOR, IS PAID FOR BY CHI ST. ALEXIUS MEDICAL CENTER. THE HOSPITAL HAS A MANAGEMENT SERVICES AGREEMENT WITH ST. ALEXIUS TO PROVIDE THESE CEO SERVICES TO THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 3 THE FOLLOWING WERE THE MANAGING DUTIES PERFORMED BY A MANAGING AGENT: HIRING EMPLOYEES, FIRING EMPLOYEES, SUPERVISING PERSONNEL, PLANNING OR EXECUTING BUDGETS/FINANCIAL OPERATIONS, SUPERVISING EXEMPT OPERATIONS, AND SUPERVISING UNRELATED TRADES OR BUSINESSES OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE TAX RETURN IS INCLUDED IN EACH BOARD MEMBER'S PACKET BEFORE IT IS SUBMITTED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C MANAGEMENT IS RESPONSIBLE FOR HONORING AND ENFORCING THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS APPROVES THE CEO'S SALARY BASED UPON THE STATE AVERAGE FROM SIMILAR-SIZED ORGANIZATIONS FROM THE ND HOSPITAL ASSOCIATION (NDHA) SALARY SURVEY. THE CEO IS RESPONSIBLE FOR DETERMINING THE SALARIES OF KEY EMPLOYEES. HE/SHE USED THE NDHA SALARY SURVEY AS A REFERENCE WHICH INCLUDES ALL ND FACILITIES WHO REPORT ON AN ANNUAL BASIS. SALARIES BY POSITION ARE COMPARED TO BENCHMARK AMOUNTS IN NORTH DAKOTA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. MANAGEMENT IS RESPONSIBLE FOR HONORING THESE REQUESTS. FORM 990, PART XII, LINE 2C THE HOSPITAL DID NOT CHANGE ITS OVERSIGHT PROCESS OF THE AUDIT DURING THE YEAR. LINTON HOSPITAL FOUNDATION 518 N BROADWAY LINTON ND 58552 141842061 CHARITABLE FOUNDATION ND 501(C)(3) LINE 11 N/A 0 0 0 1 0 0 0 0 1 0 0 1 0 0 1 0 0 1 1 0