INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSN: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSN (EIN 41-0726171)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-17
- IRS object ID
- 201403219349302710
- Schema version
- 2013v3.0
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-17T09:44:27-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410726171 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | INTE | BusinessNameControlTxt |
| Phone | 2182835401 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 HIGHWAY 71 | AddressLine1 |
| City | INTERNATIONAL FALLS | City |
| State | MN | State |
| ZIP Code | 56649 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MELISSA MARCOTTE | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 2182835401 | PhoneNum |
| Signature | 2014-11-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DARRYN MCGARVEY | PreparerPersonNm |
| PTIN | P00958683 | PTIN |
| Phone | 6123764500 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RAINY LAKE MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAN ODEGAARD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 HIGHWAY 71 | AddressLine1 |
| City | INTERNATIONAL FALLS | City |
| State | MN | State |
| ZIP Code | 56649 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $24,564,855 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.RAINYLAKEMEDICAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1945 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | TO PROMOTE AND PROVIDE HEALTH CARE AND WELLNESS SERVICES IN OUR REGION THAT EXCEED EXPECTATIONS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 202 | TotalEmployeeCnt |
| Total Volunteers | 26 | TotalVolunteersCnt |
| Total Gross UBI | $12,648 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$149 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $88,186 | PYContributionsGrantsAmt |
| CY Contributions Grants | $135,431 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $25,195,442 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $24,098,008 | CYProgramServiceRevenueAmt |
| PY Investment Income | $102,178 | PYInvestmentIncomeAmt |
| CY Investment Income | $25,801 | CYInvestmentIncomeAmt |
| PY Other Revenue | $583,760 | PYOtherRevenueAmt |
| CY Other Revenue | $305,615 | CYOtherRevenueAmt |
| PY Total Revenue | $25,969,566 | PYTotalRevenueAmt |
| CY Total Revenue | $24,564,855 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,595,663 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,341,588 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $8,123 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $16,007,657 | PYOtherExpensesAmt |
| CY Other Expenses | $16,346,543 | CYOtherExpensesAmt |
| PY Total Expenses | $25,603,320 | PYTotalExpensesAmt |
| CY Total Expenses | $25,688,131 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $366,246 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,123,276 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $21,869,475 | TotalAssetsBOYAmt |
| Total Assets EOY | $21,405,376 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,977,792 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,422,927 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $18,891,683 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $17,982,449 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO SERVE PATIENTS AND PROMOTE WELLNESS, AND TO BE THE COMMUNITY'S TRUSTED CHOICE FOR HEALTHCARE BY PLACING PATIENTS FIRST, PROMOTING WELLNESS, EMBRACING CHANGE, AND FACILITATING A SEAMLESS CONTINUUM OF CARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $19,803,953 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $24,098,008 | RevenueAmt |
| Desc | PROVIDED HEALTH CARE SERVICES TO THE COMMUNITY OF INTERNATIONAL FALLS. IN ADDITION TO PROVIDING DIRECT PATIENT CARE AND IN FURTHERANCE OF ITS CHARTIABLE PURPOSE, RAINY LAKE MEDICAL CENTER (RLMC) PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY INCLUDING OFFERING VARIOUS COMMUNITY BASED SERVICE PROGRAMS, CASH CONTRIBUTIONS TO NON-PROFIT AGENCIES, THE DONATION OF SPACE FOR USE BY COMMUNITY GROUPS, AND STAFF TIME OF MENTORING/JOB SHADOWING. ADDITIONALLY, A NUMBER OF HEALTH RELATED EDUCATION PROGRAMS ARE PROVIDED FOR THE BENEFIT OF THE COMMUNITY, INCLUDING HEALTH ENHANCEMENTS AND WELLNESS, CLASSES ON SPECIFIC CONDITIONS, AND PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. RLMC ALSO ACTIVELY PROMOTES ITS COMMUNITY CARE PROGRAM, WHICH PROVIDES FREE OR REDUCED-COST HEALTHCARE TO PATIENTS WHO ARE UNABLE TO PAY FULLY FOR SERVICES RECEIVED. DURING 2013, THERE WERE 7931 EMERGENCY/URGENT CARE VISITS, 75 DELIVERIES, 424 ACUTE CARE ADMISSIONS, AND 1580 TOTAL PATIENT DAYS. | Desc |
| Total Program Service Expenses | $19,803,953 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | 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 | 35 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 202 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | 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 | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MELISSA MARCOTTE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2182835431 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 HIGHWAY 71 | AddressLine1 |
| City | INTERNATIONAL FALLS | City |
| State | MN | State |
| ZIP Code | 56649 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| CHARLES HELLELOID MD | ||||||||
| CHAIR | 4.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $31 | |
| SUSAN CONGRAVE | ||||||||
| VICE-CHAIR | 4.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $32 | |
| BILL DOUGHERTY | ||||||||
| SECRETARY | 4.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $32 | |
| DON BILLIG | ||||||||
| TREASURER | 4.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $11 | |
| ROBERT ANDERSON | ||||||||
| MEMBER | 4.00 | 0.00 | Yes (X) | $0 | $0 | $11 | ||
| JOSEPH BIANCO MD | ||||||||
| MEMBER | 4.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| BRIAN BRIGGS | ||||||||
| MEMBER | 4.00 | 2.00 | Yes (X) | $0 | $0 | $17 | ||
| GEORGE COCHRAN | ||||||||
| MEMBER | 4.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| BONNIE ERICKSON | ||||||||
| MEMBER | 4.00 | 0.00 | Yes (X) | $0 | $0 | $27 | ||
| JEFF HARDWIG MD | ||||||||
| MEMBER | 4.00 | 0.00 | Yes (X) | $0 | $0 | $32 | ||
| JAY KNAAK MD | ||||||||
| MEMBER | 4.00 | 0.00 | Yes (X) | $0 | $0 | $27 | ||
| MIKE MOTLEY | ||||||||
| MEMBER | 4.00 | 0.00 | Yes (X) | $0 | $0 | $32 | ||
| BRAD REINERS | ||||||||
| MEMBER | 4.00 | 0.00 | Yes (X) | $0 | $0 | $32 | ||
| GAIL ROGNERUD | ||||||||
| MEMBER | 4.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MARTIN SINCLAIR | ||||||||
| MEMBER | 4.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| ANTHONY STONE MD | ||||||||
| MEMBER | 4.00 | 0.00 | Yes (X) | $0 | $0 | $32 | ||
| JON TALSNESS MD | ||||||||
| MEMBER | 4.00 | 0.00 | Yes (X) | $0 | $0 | $11 | ||
| BOB HALEY | ||||||||
| INTERIM CEO | 39.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MELISSA MARCOTTE | ||||||||
| CFO | 39.00 | 1.00 | Yes (X) | $118,883 | $0 | $3,966 | ||
| DONITA ETTESTAD | ||||||||
| CNO | 40.00 | 0.00 | $102,702 | $0 | $4,611 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $221,585 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $8,904 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ESSENTIA HEALTHDULUTH CLINIC | |||||
| 400 EAST 3RD STREET | DULUTH | MN | 55805 | PROFESSIONAL & MANAGEMENT SERVICES FOR C | $3,876,316 |
| WAPITI MEDICAL GROUP | |||||
| PO BOX 92 | NEWELL | SD | 57760 | ER PHYSICIAN FEES | $1,234,915 |
| CONNECT HEALTHCARE LLC | |||||
| 107 FLYNN DRIVE SUITE 600 | MILBANK | SD | 57252 | HOSPITALIST PHYSICIAN FEES | $845,825 |
| CMDI | |||||
| 150 10TH ST NW | MILACA | MN | 56353 | CT, ULTRASOUND AND MAMMOGRAPHY LEASE | $532,080 |
| QUORUM HEALTH RESOURCES | |||||
| 105 CONTINENTAL PLACE | BRENTWOOD | TN | 37027 | MANAGEMENT SERVICES; CONTRACT CEO | $489,477 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 16 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $27,184 | RelatedOrganizationsAmt |
| All Other Contributions | $108,247 | AllOtherContributionsAmt |
| Noncash Contributions | $11,728 | NoncashContributionsAmt |
| Total Contributions | $135,431 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $24,098,008 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,085,360 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $12,648 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $24,098,008 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,801 | TotalRevenueColumnAmt |
| Exclusion | $25,801 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $27,681 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $27,681 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $27,681 | TotalRevenueColumnAmt |
| Exclusion | $27,681 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CT SERVICES | 900099 | $176,100 | $176,100 |
| OTHER REVENUE | 900099 | $76,461 | $76,461 |
| MEANINGFUL USE REVENUE | 900099 | $25,373 | $25,373 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $277,934 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,564,855 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,085,360 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $12,648 | UnrelatedBusinessRevenueAmt |
| Exclusion | $331,416 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $122,849 | TotalAmt |
| Management And General | $122,849 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,446,289 | TotalAmt |
| Program Services | $5,735,199 | ProgramServicesAmt |
| Management And General | $1,702,967 | ManagementAndGeneralAmt |
| Fundraising | $8,123 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $241,840 | TotalAmt |
| Program Services | $222,100 | ProgramServicesAmt |
| Management And General | $19,740 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $950,772 | TotalAmt |
| Program Services | $810,592 | ProgramServicesAmt |
| Management And General | $140,180 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $579,838 | TotalAmt |
| Program Services | $494,348 | ProgramServicesAmt |
| Management And General | $85,490 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $764,256 | TotalAmt |
| Management And General | $764,256 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $201,395 | TotalAmt |
| Management And General | $201,395 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,762 | TotalAmt |
| Management And General | $48,762 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,880,789 | TotalAmt |
| Program Services | $6,703,005 | ProgramServicesAmt |
| Management And General | $1,177,784 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,206 | TotalAmt |
| Management And General | $32,206 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $425,328 | TotalAmt |
| Program Services | $260,231 | ProgramServicesAmt |
| Management And General | $165,097 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $449,984 | TotalAmt |
| Program Services | $33,027 | ProgramServicesAmt |
| Management And General | $416,957 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $299,028 | TotalAmt |
| Program Services | $293,861 | ProgramServicesAmt |
| Management And General | $5,167 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,696 | TotalAmt |
| Program Services | $2,552 | ProgramServicesAmt |
| Management And General | $13,144 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $731,115 | TotalAmt |
| Program Services | $731,115 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,404 | TotalAmt |
| Management And General | $82,404 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| CLINIC PATIENT SERVICES | $3,177,667 | $3,177,667 | |
| BAD DEBT EXPENSE | $872,605 | $872,605 | |
| TAXES AND SURCHARGES | $401,797 | $401,797 | |
| MEDICAL SUPPLIES | $332,304 | $332,304 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $631,207 | TotalAmt |
| Program Services | $135,347 | ProgramServicesAmt |
| Management And General | $495,860 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,688,131 | TotalAmt |
| Program Services | $19,803,953 | ProgramServicesAmt |
| Management And General | $5,876,055 | ManagementAndGeneralAmt |
| Fundraising | $8,123 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,862,717 | BOYAmt |
| EOY | $11,969,897 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,922,800 | BOYAmt |
| EOY | $2,362,483 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $355,219 | BOYAmt |
| EOY | $416,410 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $122,632 | BOYAmt |
| EOY | $107,909 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $14,982,871 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $9,082,406 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,702,874 | BOYAmt |
| EOY | $5,900,465 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $684,233 | BOYAmt |
| EOY | $648,212 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $219,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,869,475 | BOYAmt |
| EOY | $21,405,376 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,564,202 | BOYAmt |
| EOY | $2,552,820 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $413,590 | BOYAmt |
| EOY | $870,107 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,977,792 | BOYAmt |
| EOY | $3,422,927 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,891,683 | BOYAmt |
| EOY | $17,946,302 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $36,147 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,891,683 | BOYAmt |
| EOY | $17,982,449 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,869,475 | BOYAmt |
| EOY | $21,405,376 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,123,276 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $214,042 | 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 D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $161,319 | OtherCostOrOtherBasisAmt |
| Book Value | $161,319 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,961,003 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,549,828 | DepreciationAmt |
| Book Value | $4,411,175 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $156,684 | OtherCostOrOtherBasisAmt |
| Depreciation | $121,761 | DepreciationAmt |
| Book Value | $34,923 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,384,359 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,410,817 | DepreciationAmt |
| Book Value | $973,542 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $319,506 | OtherCostOrOtherBasisAmt |
| Book Value | $319,506 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,900,465 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO RELATED PARTY | $289,523 |
| OTHER LIABILITIES | $483,758 |
| ASSET RETIREMENT OBLIGATION | $96,826 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $870,107 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE CENTER HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE CENTER FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT OF THE CENTER'S CONSOLIDATED FINANCIAL STATEMENTS. THE CENTER'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE TAX RETURNS FOR THE YEARS 2011 TO 2013 ARE OPEN TO EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | 0 | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $346,659 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $346,659 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01350 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,530,250 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,081,849 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,448,401 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05640 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,876,909 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,081,849 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,795,060 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06990 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,131 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,131 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,687 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $11,687 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,305 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,305 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,123 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $26,123 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,903,032 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,081,849 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,821,183 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07100 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $138 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $138 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,285 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,285 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $28,741 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $28,741 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,164 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $30,164 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $872,605 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $90,334 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $8,586,336 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,303,753 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $282,583 | 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 | RAINY LAKE MEDICAL CENTER | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 HIGHWAY 71 | AddressLine1 |
| City | INTERNATIONAL FALLS | City |
| State | MN | State |
| ZIP Code | 56649 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.RAINYLAKEMEDICAL.COM | WebsiteAddressTxt |
| State License | 365894 | 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 | PROVIDER-BASED CLINIC | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RAINY LAKE MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTP://RAINYLAKEMEDICAL.COM/WP-CONTENT/UP | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Other Factors | Yes (X) | OtherFactorsInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| RAINY LAKE MEDICAL CENTER | PART V, SECTION B, LINE 3: RLMC WORKED WITH THE KOOCHICHING COUNTY HEALTH DEPARTMENT TO COMPLETE ITS COMMUNITY HEALTH NEEDS ASSESSMENT. A REPRESENTATIVE OF RLMC AND THE DIRECTOR OF THE KOOCHICHING COUNTY HEALTH DEPARTMENT MET WITH 34 KEY COMMUNITY STAKEHOLDERS REPRESENTING A BROAD SECTION OF THE COMMUNITY INCLUDING LOCAL SERVICE PROVIDERS, MEMBERS OF THE RELIGIOUS COMMUNITY, BUSINESS OWNERS, AND CITIZENS FROM INTERNATIONAL FALLS AND THE GREATER COUNTY. THE AGENCIES REPRESENTED INCLUDED THOSE SERVING THE MEDICALLY UNDERSERVED AND LOW-INCOME POPULATIONS OF INTERNATIONAL FALLS AND KOOCHICHING COUNTY. RLMC ALSO CONDUCTED KEY STAKEHOLDER MEETINGS THROUGHOUT ITS SERVICE AREA, INTERVIEWING GROUPS OF INDIVIDUALS IDENTIFIED AS INFORMAL COMMUNITY LEADERS AND INTERESTED CITIZENRY. |
| RAINY LAKE MEDICAL CENTER | PART V, SECTION B, LINE 7: THE FOLLOWING ARE COMMUNITY NEEDS THAT WERE IDENTIFIED BUT NOT ADDRESSED BY RLMC: A) THE HIGH COST OF HEALTHCARE AND LACK OF HEALTH INSURANCE (OUTSIDE OF RLMC'S MISSION). B) LACK OF MENTAL HEALTH PRACTITIONERS (OUTSIDE OF RLMC'S MISSION). C) TRANSPORTATION (OUTSIDE OF RLMC'S MISSION). D) ACCESS TO HEALTH-RELATED SERVICES SUCH AS MEAL PROGRAMS, HOME CARE AND ALZHEIMER SUPPORT PROGRAMS (DUPLICATION OF EFFORT WITH LOCAL COUNTY HEALTH DEPARTMENT). E) SMOKING RATES AMONG TEENS (DUPLICATION OF EFFORT WITH LOCAL COUNTY HEALTH DEPARTMENT). F) OVERUSE OF ALCOHOL (OUTSIDE OF RLMC'S MISSION). G) DRUG ABUSE (OUTSIDE OF RLMC'S MISSION). H) THE IMPACT OF GEOGRAPHIC ISOLATION ON MENTAL HEALTH AND THE DESIRE TO BE HEALTHY (OUTSIDE OF RLMC'S MISSION). I) ACCESS TO LOCAL MENTAL HEALTH PROVIDERS AS WELL AS REGIONAL TREATMENT FACILITIES (LIMITED RESOURCES). |
| RAINY LAKE MEDICAL CENTER | PART V, SECTION B, LINE 12I: ELIGIBILITY FOR THE HOSPITAL'S COMMUNITY CARE PROGRAM IS BASED ON THREE CRITERIA: YOUR INCOME, YOUR RESOURCES, AND YOUR APPLICATION FOR, AND USE OF, ANY PRIVATE OR GOVERNMENTAL HEALTHCARE COVERAGE AVAILABLE TO YOU. |
| RAINY LAKE MEDICAL CENTER | PART V, SECTION B, LINE 20D: WE FOLLOW THE MINNESOTA ATTORNEY GENERAL AGREEMENT FOR THE MOST FAVORABLE NON-GOVERNMENTAL THIRD PARTY PAYOR THAT PROVIDED THE MOST REVENUE TO THE PROVIDER DURING THE PREVIOUS YEAR. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 6A: | RLMC MAKES ITS COMMUNITY BENEFIT REPORT AVAILABLE TO THE PUBLIC BY INCLUDING IT IN THEIR FINANCIAL STATEMENTS AND THROUGH THE MINNESOTA HOSPITAL ASSOCIATION ANNUAL REPORT. |
| PART I, LINE 7: | COSTING METHODOLOGY USED WAS A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 FOR LINES A, B, AND G. ACTUAL COSTS WERE USED TO DERIVE AMOUNTS ON LINES E, F, AND I. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | RLMC INVESTS RESOURCES TOWARDS EMERGENCY PREPAREDNESS, PARTICULARLY A "DECONTAMINATION TEAM" THAT CONDUCTS DRILLS THROUGHOUT THE YEAR. THE TEAM IS SKILLED IN SETTING UP A PORTABLE DECONTAMINATION TENT, DRESSING IN AN APPROPRIATE LEVEL OF PPE AND PRACTICING DECONTAMINATING PATIENTS. |
| PART III, LINE 2: | BAD DEBT EXPENSE OF $872,605 WAS SUBTRACTED WHEN CALCULATING THE COMMUNITY BENEFIT EXPENSE AS A PERCENT OF TOTAL EXPENSE. |
| PART III, LINE 3: | THE RATIO OF COSTS TO CHARGES CALCULATED ON WORKSHEET 2 WAS USED TO DETERMINE THE AMOUNTS ON LINES 2 AND 3. ACCOUNTS THAT WENT TO BAD DEBT WERE REVIEWED AND COMPARED TO THE COMMUNITY CARE LOG TO IDENTIFY THOSE THAT WERE NOT PROCESSED AS COMMUNITY CARE DUE TO NON-RETURN OF THE APPLICATION.SEE THE "PATIENT ACCOUNTS RECEIVABLE, NET" SECTION ON PAGE 8 OF THE ATTACHED FINANCIAL STATEMENTS FOR INFORMATION ABOUT THE CALCULATION OF BAD DEBT EXPENSE. |
| PART III, LINE 8: | THERE WAS NO SHORTFALL CALCULATED IN 2013. THE AMOUNTS INCLUDED IN PART III, LINES 6-8 WERE DERIVED USING THE 2013 FILED MEDICARE COST REPORT. |
| PART III, LINE 9B: | RLMC WILL NOT REFER AN ACCOUNT TO A THIRD PARTY DEBT COLLECTION AGENCY UNLESS RLMC HAS GIVEN THE PATIENT REASONABLE OPPORTUNITY TO SUBMIT A COMMUNITY CARE APPLICATION IF THE FACTS AND CIRCUMSTANCES SUGGEST THE PATIENT MAY BE ELIGIBLE FOR COMMUNITY CARE, INCLUDING FOR EXAMPLE, IF THE PATIENT IS UNINSURED OR IS ON MINNESOTA CARE, MEDICAL ASSISTANCE, OR OTHER RELIEF BASED ON NEED. IF A PATIENT SUBMITS AN APPLICATION FOR COMMUNITY CARE AFTER AN ACCOUNT HAS BEEN REFERRED FOR COLLECTION ACTIVITY, RLMC WILL SUSPEND ALL COLLECTION ACTIVITY UNTIL THE PATIENT'S APPLICATION HAS BEEN PROCESSED AND THE PATIENT HAS BEEN NOTIFIED OF THE DECISION. |
| PART VI, LINE 2: | RLMC WORKED WITH THE KOOCHICHING COUNTY HEALTH DEPARTMENT TO COMPLETE ITS COMMUNITY HEALTH NEEDS ASSESSMENT. A REPRESENTATIVE OF RLMC AND THE DIRECTOR OF THE KOOCHICHING COUNTY HEALTH DEPARTMENT MET WITH 34 KEY COMMUNITY STAKEHOLDERS REPRESENTING A BROAD SECTION OF THE COMMUNITY INCLUDING LOCAL SERVICE PROVIDERS, MEMBERS OF THE RELIGIOUS COMMUNITY, BUSINESS OWNERS, AND CITIZENS FROM INTERNATIONAL FALLS AND THE GREATER COUNTY. THE AGENCIES REPRESENTED INCLUDED THOSE SERVING THE MEDICALLY UNDERSERVED AND LOW-INCOME POPULATIONS OF INTERNATIONAL FALLS AND KOOCHICHING COUNTY. RLMC ALSO CONDUCTED KEY STAKEHOLDER MEETINGS THROUGHOUT ITS SERVICE AREA, INTERVIEWING GROUPS OF INDIVIDUALS IDENTIFIED AS INFORMAL COMMUNITY LEADERS AND INTERESTED CITIZENRY. |
| PART VI, LINE 3: | RLMC HAS STAFF THAT ARE MINNESOTA COMMUNITY APPLICATION AGENT (MNCAA) CERTIFIED, WHICH ENABLES US TO ASSIST OUR PATIENTS WITH THE MINNESOTA CARE APPLICATION PROCESS. RLMC COMMUNICATES TO PATIENTS OUR COMMUNITY CARE PROGRAM (CHARITY CARE) IN THE FOLLOWING MANNER:1. PATIENTS ARE GIVEN A COMMUNITY CARE BROCHURE WITH A MINNESOTA CARE INSERT AT TIME OF SERVICE.2. STATEMENTS AND LETTERS SENT TO PATIENTS OFFERING COMMUNITY CARE.3. PHONE CALLS ARE MADE TO PATIENTS TO DISCUSS AND OFFER COMMUNITY CARE AND ASSISTANCE WITH THE MINNESOTA CARE APPLICATION PROCESS.4. ALL EMPLOYEES ARE EDUCATED ANNUALLY ABOUT OUR COMMUNITY CARE PROGRAM AND THREE EMPLOYEES ARE EDUCATED TO COMPLETE AND SUBMIT MINNESOTA CARE APPLICATIONS TO THE STATE FOR PROCESSING.5. UPON REQUEST, COMMUNITY CARE PACKETS WITH APPLICATIONS FOR BOTH OUR COMMUNITY CARE PROGRAM AND THE MINNESOTA CARE INSURANCE ARE SENT OR GIVEN TO PATIENTS.6. THE RLMC WEBSITE DISPLAYS PAYMENT OPTIONS WHERE OUR COMMUNITY CARE PROGRAM IS DISCUSSED.7. ONE OF THE REQUIREMENTS FOR RLMC COMMUNITY CARE IS A DENIAL FROM THE COUNTY IN REGARDS TO FINANCIAL ASSISTANCE UNLESS THEY ARE ENROLLED IN THE MN SENIOR PROGRAM. WE OFFER TO ASSIST THEM WITH THEIR MEDICAL ASSISTANCE APPLICATION. |
| PART VI, LINE 4: | RLMC PRIMARILY SERVES THE POPULATION OF KOOCHINCHING COUNTY, MINNESOTA. THE COUNTY IS LARGE AND SPARSELY POPULATED WITH INTERNATIONAL FALLS AS THE MAIN POPULATION CENTER. OTHER NEARBY SMALLER COMMUNITIES INCLUDE LITTLEFORK, BIG FALLS, RANIER, BIRCHDALE AND LOMAN. COLLECTIVELY THESE COMMUNITIES MAKE UP THE PRIMARY SERVICE AREA (PSA). THE PSA HAS AN ESTIMATED POPULATION OF AROUND 12,000 AND IS PROJECTED TO CONTINUALLY DECLINE. THE AVERAGE DISPOSABLE HOUSEHOLD INCOME IS AROUND $49,000 WHICH IS 6% LOWER THAN THE U.S. AVERAGE. APPROXIMATELY 19% OF THE POPULATION IS OVER THE AGE OF 65. |
| PART VI, LINE 5: | REPRESENTATION ON THE BOARD IS PREDOMINANTLY LOCAL AS THE BYLAWS STATE THAT NO MORE THAN 4 TRUSTEES MAY RESIDE OUTSIDE OF THE SERVICE AREA. RLMC HAS IN PLACE AN OPEN MEDICAL STAFF MODEL. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE WILL CONSIST OF THE BOARD CHAIR AS CHAIRPERSON, THE BOARD VICE CHAIR, THE BOARD SECRETARY, THE BOARD TREASURER, AND TWO OTHER MEMBERS OF THE BOARD OF TRUSTEES (ONE AN ESSENTIA HEALTH TRUSTEE AND ONE A FALLS TRUSTEE) DETERMINED BY THE BOARD OF TRUSTEES AT ITS FIRST MEETING AFTER ELECTION. THE EXECUTIVE COMMITTEE WILL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE INTERIM BETWEEN THE MEETINGS OF THE BOARD OF TRUSTEES, PROVIDED ANY ACTION TAKEN WILL NOT CONFLICT WITH THE POLICIES AND EXPRESSED WISHES OF THE BOARD OF TRUSTEES, AND THAT IT WILL REFER ALL MATTERS OF MAJOR IMPORTANCE TO THE BOARD OF TRUSTEES. |
| FORM 990, PART VI, SECTION A, LINE 2 | BOARD MEMBERS CHARLES HELLELOID, MARTIN SINCLAIR, MIKE MOTLEY, JOSEPH BIANCO, JEFF HARDWIG, BRAD REINERS, AND ANTHONY STONE ARE EMPLOYEES OF ESSENTIA HEALTH. |
| FORM 990, PART VI, SECTION A, LINE 3 | THE HOSPITAL'S INTERIM CEO IS AN EMPLOYEE OF QUORUM HEALTH RESOURCES. THE HOSPITAL HAS AN AGREEMENT WITH QUORUM AND PAYS THEM MANAGEMENT FEES. |
| FORM 990, PART VI, SECTION A, LINE 7A | ONE HALF OF THE MEMBERS OF THE BOARD OF TRUSTEES SHALL BE APPOINTED BY ESSENTIA HEALTH. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS REVIEWED BY THE CFO, CEO, AND FINANCE COMMITTEE. IN ADDITION, A COPY OF THE RETURN IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW BEFORE IT IS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION'S OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REMINDED OF THE CONFLICT OF INTEREST POLICY AND MUST SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. DISCLOSURES OF CONFLICTS FOR THE BOARD OF TRUSTEE MEMBERS IS DISTRIBUTED AT EVERY BOARD MEETING. WHEN A CONFLICT OF INTEREST EXISTS, THE INTERESTED TRUSTEE MAY BE PRESENT FOR DISCUSSION TO ANSWER QUESTIONS, BUT MAY NOT ADVOCATE FOR THE ACTION TO BE TAKEN AND MAY BE ASKED TO LEAVE THE ROOM WHILE A VOTE IS TAKEN. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE NOT OPEN TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 5,210,097. MANAGEMENT AND GENERAL EXPENSES 744,283. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,954,380. CONTRACTED/PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,492,908. MANAGEMENT AND GENERAL EXPENSES 406,749. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,899,657. PUBLIC RELATIONS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 6,243. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,243. SERVICE CHARGES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 20,509. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,509. |
| FORM 990, PART XI, LINE 9: | CHANGE IN RECOGNIZED PENSION COSTS 188,766. CHANGE IN INTEREST IN FOUNDATION 25,276. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FALLS MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 HIGHWAY 71 | AddressLine1 |
| City | INTERNATIONAL FALLS | City |
| State | MN | State |
| ZIP Code | 56649 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 204585807 | EIN |
| Primary Activities | SUPPORT | PrimaryActivitiesTxt |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 11A, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RAINY LAKE MEDICAL CENTER | BusinessNameLine1 |
| 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 | 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 | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RAINY LAKE MEDICAL CENTER FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $27,184 | InvolvedAmt |
| Method Of Amount Determination | FMV | MethodOfAmountDeterminationTxt |