2013-03-26T07:37:48-05:00 2012-06-30 390758449 WIPFLI LLP 7601 FRANCE AVENUE SOUTH SUITE 400 MINNEAPOLIS MN 55435 990 2011-07-01 450231181 LUTHERAN CHARITY ASSOCIATION LUTH 7012521050 2422 20TH ST SW JAMESTOWN ND 584013360 BRANDON VAUGHAN 7012521050 2013-02-28 1 KRISTEN HAGER CPA P01359220 9525483400 2013-02-28 2011 2016-02-25 16:41:14Z X JAMESTOWN REGIONAL MEDICAL CENTER BRANDON VAUGHAN 2422 20TH ST SW JAMESTOWN ND 584013360 35466142 0 X WWW.JRMCND.COM X 1927 ND JAMESTOWN REGIONAL MEDICAL CENTER WILL BE THE BEST RURAL HOSPITAL IN THE COUNTRY FOR PATIENTS TO RECEIVE CARE, EMPLOYEES TO WORK, AND PHYSICIANS TO PRACTICE. 10 10 371 119 0 0 1488870 1248424 26333441 33842417 474773 -3379352 331462 16090 28628546 31727579 0 0 0 0 15714644 17774868 0 0 0 10885898 18100679 26600542 35875547 2028004 -4147968 73203276 72928174 46902922 50820757 26300354 22107417 X EXCEED EXPECTATIONS AND BE THE DIFFERENCE IN THE LIVES OF THOSE WE SERVE. 1 0 30779880 33594430 JAMESTOWN REGIONAL MEDICAL CENTER IS A 25 BED CRITICAL ACCESS HOSPITAL PROVIDING SHORT-TERM ACUTE INPATIENT, OUTPATIENT, SWING BED, HOME HEALTH AND HOSPICE HEALTH CARE SERVICES. THE NEAREST PROVIDER OF HEALTH CARE SERVICES IS MORE THEN 35 MILES AWAY AND JAMESTOWN REGIONAL MEDICAL CENTER IS LOCATED 100 MILES AWAY FROM THE NEAREST MAJOR HEALTH SERVICE CENTERS IN FARGO OR BISMARCK, NORTH DAKOTA. WE ALSO PROVIDE SPACE FOR A SATELLITE DIALYSIS UNIT OPERATED BY MEDCENTER ONE, BISMARCK, NORTH DAKOTA. JAMESTOWN REGIONAL MEDICAL CENTER MAKES MEDICAL CARE ACCESSIBLE TO THE ENTIRE COMMUNITY IT SERVES. IN ADDITION TO THE ROUTINE INPATIENT AND OUTPATIENT HEALTH CARE SERVICES WE PROVIDE THE FOLLOWING SPECIALTY SERVICES TO THE COMMUNITIES WE SERVE:* CARDIAC CARE AND REHABILITATION: IN ADDITION TO EMERGENCY AND INTENSIVE CARE UNITS OUR CARDIAC SERVICES INCLUDE CARDIOLITE STRESS, ADENOSCAN AND ADENOWALK CARDIOLITE IMAGING TESTS AND SPECT IMAGING TESTS FOR ACCURATE DIAGNOSIS; AND MONITORED DIET AND EXERCISE PROGRAMS THROUGHOUT THE HOSPITAL STAY AND THROUGH OUTPATIENT CARE IN OUR CARDIAC REHABILITATION CENTER.* MAMMOGRAPHY: OUR MAMMOGRAPHY UNIT WAS DESIGNED FOR WOMEN AND IS STAFFED BY FEMALE PROFESSIONALS. * EMERGENCY CARE: OUR EMERGENCY CENTER IS STAFFED 24 HOURS A DAY THROUGHOUT THE YEAR AND HANDLES EVERYTHING FROM BROKEN BONES TO HEART ATTACKS.* HOME HEALTH SERVICES: SERVICES PROVIDED TO THE HOME BOUND INCLUDE NURSING, PHYSICAL, OCCUPATIONAL, SPEECH AND SOCIAL SERVICES.* HOSPICE: PROVIDE FOR THE PHYSICAL AND PSYCHOLOGICAL NEEDS OF THE TERMINALLY ILL AND HELP ACCOMODATE THEIR FAMILIES THROUGH A FULL RANGE OF HOSPICE SERVICES.* NUTRITIONAL COUNSELING: OUR REGISTERED DIETITIANS PROVIDE NUTRITIONAL ASSESSMENTS AND PERSONALIZED DIET PLANS TO OPTIMIZE HEALTH AND SPEED RECOVERY THROUGH PROPER NUTRITION.* PHYSICAL AND OCCUPATIONAL THERAPY: PROVIDE A FULL RANGE OF SERVICES TO HELP PATIENTS RECOVER FROM ON-THE-JOB, SPORTS-RELATED INJURIES AND CERTAIN DEBILITATING DISEASES.* SOCIAL SERVICES AND SUPPORT GROUPS: OUR FACILITY PROVIDES A WIDE RANGE OF SUPPORT IN THE COORDINATION OF SERVICES BY OUR SOCIAL SERVICE DEPARTMENT AND SUPPORT GROUPS TO HELP OUR PATIENTS AND THEIR FAMILIES COPE WITH THE EMOTIONAL AND FINANCIAL EFFECTS OF ILLNESS.* PODIATRY SERVICES: OUR LICENSED AND CREDENTIALED DOCTOR OF PODIATRY MEDICINE TREATS EVERYTHING FROM FLAT FEET TO BUNIONS WITH MODERATE THERAPEUTIC TECHNIQUES.* SPEECH AND HEARING SERVICES: WE EMPLOY LICENSED AUDIOLOGIST AND SPEECH THERAPISTS THAT CAN HELP CORRECT HEARING LOSS AND SPEECH DIFFICULTIES.* SURGERY CENTER: OUR INPATIENT AND OUTPATIENT SURGERY CENTER IS CAPABLE OF HANDLING A WIDE VARIETY OF GENERAL AND SPECIALIZED SURGICAL PROCEDURES INCLUDING LAPAROSCOPIC AND CATARACT PROCEDURES.* WELLNESS PROGRAMS: OUR WELLNESS CENTER OFFERS THE COMMUNITY A FULL SCHEDULE OF CLASSES ON SUBJECTS RANGING FROM HEALTHY DIET, FITNESS AND PREVENTATIVE CARE ALONG WITH A FULLY EQUIPPED FITNESS CENTER TO HELP THE PEOPLE WE SERVE LEARN HOW TO MODIFY THEIR LIFESTYLES FOR A HEALTHIER LIFE.* OTHER SUPPORT SERVICES:* LABORATORY, PATHOLOGY AND RADIOLOGY SERVICES: FULL RANGE OF SERVICES TO PROVIDE ACCURATE DIAGNOSIS FOR TREATMENT* CARE LINE: WE OPERATE AN EMERGENCY RESPONSE TELEPHONE BASED RESPONSE CENTER TO ENABLE THE FRAIL ELDERLY TO REMAIN INDEPENDENT IN THEIR HOMES.* VOLUNTEERS AND VOLUNTEER SERVICES: WE HAVE, ON THE AVERAGE, 112 COMMUNITY VOLUNTEERS PROVIDING APPROXIMATELY 6,435 HOURS OF SERVICE TO THE HOSPITAL AND THE PATIENTS WE SERVE. SOME OF THE MANY AREAS THEY PROVIDE SERVICES ARE AS FOLLOWS:* SENIOR COMPANIONS: HELPING SENIOR CITIZENS MAINTAIN INDEPENDENCE BY READING TO THEM, HELPING WITH SHOPPING, ETC.* HOSPICE: ASSISTING HOSPICE PATIENTS AND FAMILIES COPE WITH TERMINAL ILLNESS.* CHILDREN'S TLC: VOLUNTEERS PROVIDE PARENTS WITH A BREAK WITH THEIR CHILDREN THAT ARE HOSPITALIZED.* TELECARE: MAINTAIN CONTACT WITH YOUR FRIENDS OR FAMILY MEMBER THROUGH TELEPHONE CALLS TO THEIR HOME.* GIFT SHOPPE: OPERATED FOR THE CONVENIENCE OF FRIENDS AND FAMILY OF HOSPITAL PATIENTS TO OBTAIN CARDS, FLOWERS AND SMALL GIFTS FOR PATIENTS IN OUR FACILITY. * CARING TOUCH: A PARTNERSHIP WITH JAMESTOWN COLLEGE TO PROVIDE SUPPORT OF PATIENTS BOTH IN THE HOSPITAL AND AFTER THEY RETURN HOME.* OTHER SERVICES: COMMUNITY MEMBERS VOLUNTEER THEIR SERVICES TO HELP OUT IN TIMES OF NEED IN MOST SERVICE AREAS ASSISTING PATIENTS AND THEIR FAMILIES. SERVICES PROVIDED DURING FYE JUNE 30, 2012:*4,781 INPATIENT DAYS OF WHICH 346 WERE SWING BED AND 23 HOSPICE DAYS OF CARE* 43.9% MEDICARE IS THE PERCENTAGE OF INPATIENT DAYS* 14.5% MEDICAID IS THE PERCENTAGE OF INPATIENT DAYS* 8,276 EMERGENCY VISITS OF WHICH 802 RESULTED IN INPATIENT ADMISSIONS*28,916 TOTAL OUTPATIENT VISITS* 2,560 OUTPATIENT SURGICAL PROCEDURE VISITS INCLUDING OUTPATIENT SURGERY AND SCOPES* 345 LIVE BIRTHS* 1,381 ORTHOPEDIC PATIENTS* 1,766 CARDIAC REHAB VISITS* 5,004 HOME HEALTH VISITS* 4,192 HOSPICE DAYS OF CARE* 1,522 DIALYSIS TREATMENTS* $595,237 IN FREE CARE* 119 VOLUNTEERS PROVIDED 6,888 HOURS OF VOLUNTEER SERVICE.IN SUMMARY, JAMESTOWN REGIONAL MEDICAL CENTER IS A 25 BED CRITICAL ACCESS HOSPITAL, GEOGRAPHICALLY LOCATED IN RURAL SOUTH-CENTRAL NORTH DAKOTA. THE CLOSEST MEDICAL FACILITY IS MORE THAN 35 MILES AWAY AND THE CLOSEST COMPARABLE MEDICAL SERVICES ARE 100 MILES FROM JAMESTOWN. 30779880 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 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 1 0 0 1 46 0 1 371 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X BRANDON VAUGHAN 7012521050 2422 20TH ST SW JAMESTOWN ND 58401 HARVEY HUBER 1.00 X X 0 0 0 CONNIE KRAPP 1.00 X X 0 0 0 REV TERRY ANDERSON 1.00 X X 0 0 0 JOANNE H OTTMAR 1.00 X X 0 0 0 DAVID MATHISON MD 1.00 X 0 0 0 ERIC MONSON 1.00 X 0 0 0 DENNIS D POZARNSKY 1.00 X 0 0 0 DR JAMES R TORRANCE MD 1.00 X 0 0 0 SHANDA TRAISER PHD 1.00 X 0 0 0 DEBRA A GEIER MD 1.00 X 0 0 0 MARTIN RICHMAN 1111-123111 40.00 X 194351 0 33341 TODD HUDSPETH 40.00 X 79071 0 3293 ALAN O'NEIL 40.00 X 151128 0 20674 DR ALFONSO FINDLEY 40.00 X 550492 0 40635 DR PHILIP JYSTAD 40.00 X 303573 0 37407 DR SCOTT GOECKE 40.00 X 304842 0 33005 DR MANUEL HARRIS 40.00 X 238456 0 38230 DR EUGENE MEAD 40.00 X 237221 0 4979 2059134 0 211564 19 0 1 0 AMERISOURCE BERGEN 27550 NETWORK PLACE CHICAGO IL 60673 PHARMACEUTICAL SERVICES 1211618 NATIONAL MEDICAL RESOURCES INC 2900 E BROADWAY AVE STE 1 BISMARCK ND 58501 ER PHYSICIANS 839498 OWENS & MINOR 2151 COUNTY ROAD H2 WEST MOUNDS VIEW MN 55112 MEDICAL-SURGICAL SERVICES 663538 TLSC LLC CONSTRUCTION 8 7TH ST N FARGO ND 58102 CONSTRUCTION OF MODULAR BUILDING FOR CLI 563985 IMAGING SOLUTIONS INC 3223 32ND AVE S STE 201 FARGO ND 58103 DIAGNOSTIC IMAGING SERVICES 445499 27 1212687 35737 1248424 NET PATIENT SERVICE RE 621400 33081605 33081605 CAFETERIA 900099 212377 212377 WELLNESS/LIFELINE/CARE 900099 191604 191604 CONSULTATION SERVICES 541900 76877 76877 RENTAL INCOME 531120 75974 75974 203980 152280 51700 33842417 272579 272579 37606 49026 0 3738563 37606 -3689537 -3651931 -3651931 OTHER REVENUE 900099 16090 16090 16090 31727579 33594430 0 -3115275 536521 536521 13969923 12150091 1819832 929661 811029 118632 1364328 1188251 176077 974435 851790 122645 109244 109244 65100 65100 2918385 2321047 597338 217664 367 217297 4633252 3775387 857865 151970 48760 103210 719817 691854 27963 162603 107938 54665 99393 39528 59865 1947652 1947652 3704436 3704436 193501 62401 131100 DRUGS 1519284 1519284 BAD DEBT EXPENSE 939722 939722 OTHER 290001 191688 98313 FOOD 224602 224602 204053 204053 35875547 30779880 5095667 0 75395 217345 2527574 3056818 3940869 6013077 449477 552836 142271 103054 59062952 7157199 52453531 51905753 7889978 7420386 1120451 624184 4603730 3034721 73203276 72928174 8810377 3607478 790000 36960699 45632268 341846 1581011 46902922 50820757 X 26300354 22107417 26300354 22107417 73203276 72928174 X -4147968 -44969 X X 0 1 0 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6442 6442 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO VARIOUS PROFESSIONAL ORGANIZATIONS. A PORTION OF THOSE DUES ARE USED TOWARDS LOBBYING EXPENSES. 516462 516462 45684125 2110444 43573681 12836686 5046755 7789931 25679 25679 51905753 CAPITAL LEASE OBLIGATION 1581011 1581011 31727579 35875547 -4147968 -44969 -44969 -4192937 31682610 -44969 -44969 31727579 0 31727579 35875547 0 35875547 0 35875547 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740-10, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, REQUIRES AN ORGANIZATION TO ASSESS WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT DOES NOT BELIEVE THE ORGANIZATION HAS ANY MATERIAL UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS. THE ORGANIZATION'S FEDERAL INFORMATIONAL RETURNS FOR YEARS ENDED JUNE 30, 2009 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE APPLICABLE TAXING AUTHORITIES. 1 1 1 X 1 X 1 1 1 0 0 449430 449430 0.01290 3170689 2535290 635399 0.01820 3620119 2535290 1084829 0.03110 3620119 2535290 1084829 0.03110 0 709532 583770 12926281 13242434 -316153 X 1 1 1 1 JAMESTOWN REGIONAL MEDICAL CENTER

2422 20TH ST SW JAMESTOWN ND 58401

X X X X JAMESTOWN REGIONAL MEDICAL CENTER 1 1 X X X X X X X 11 1 1 1 X X X X X X X X 0 1 1 150.000000000000 1 200.000000000000 1 X X X X X 1 1 X X X X 1 X X 0 1 X 0 0 PART I, LINE 7: THE COSTING METHODOLOGY IS THE COST TO CHARGES RATIO. 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 $ 939722. PART II: JAMESTOWN REGIONAL MEDICAL CENTER PROVIDES SEVERAL LOW COST EDUCATIONAL TRAINING SESSIONS AT THE HOSPITAL AND AT DIFFERENT LOCATIONS IN THE COMMUNITY. FOR EXAMPLE, JAMESTOWN REGIONAL MEDICAL CENTER PROVIDES BREAST FEEDING, CAR SEAT TRAINING, PRENATAL TRAINING, AND HAPPIEST BABY ON THE BLOCK CLASSES. NEW YEAR NEW YOU FITNESS CHALLENGE WAS INTRODUCED IN 2008 TO ENCOURAGE AREA RESIDENTS TO MAKE POSITIVE LIFESTYLE CHANGES AND REDUCE THE RISK OF HEART DISEASE, DIABETES, OBESITY AND TOBACCO USE. PART III, LINE 4: IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE AMOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THERE WERE 272 GURANTORS GIVEN CHARITY CARE IN FY 2012. THERE WAS A TOTAL OF $595,236.50 GIVEN AS CHARITY CARE IN FY 2012. THE AVERAGE CLAIM PER GURANTOR WAS $2,188.37 AND THERE WERE AN ADDITIONAL 351 GURANTORS WHO TOOK APPLICATIONS AND DID NOT RETURN THEM. PART III, LINE 8: THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO AS REQUIRED BY MEDICARE. SHORTFALL IS NOT INDICATIVE OF ANY CHANGE IN COMMUNITY BENEFIT AS THE COSTING METHODOLOGY AND DETERMINATION OF ALLOWABLE COSTS HAVE NOT CHANGED FROM PRIOR YEAR. PART III, LINE 9B: NO COLLECTIONS EFFORT WILL BE MADE BY JAMESTOWN REGIONAL MEDICAL CENTER OR ITS COLLECTION AGENCIES ON THE PERCENTAGE OF COMMUNITY CARE APPROVED. HOWEVER, PATIENTS MUST HAVE COMPLETED THE COMMUNITY CARE APPLICATION PROCESS, ESTABLISH THEIR ELIGIBILITY, AND HAVE BEEN APPROVED. IF SUCH A PATIENT IS MISTAKENLY BILLED, HOSPITAL STAFF WILL APOLOGIZE FOR THE ERROR AND CORRECT THE MISTAKE. JAMESTOWN REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 3: LOGAN COUNTY CONDUCTED THE PAPER SURVEY. STUTSMAN COUNTY CONDUCTED THE IN-PERSON SURVEY, JAMESTOWN REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 4: CENTRAL VALLEY HEALTHSANFORD HEALTHESSENTIA HEALTHNORTH DAKOTA STATE HOSPITAL JAMESTOWN REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 7: THE TOP FOUR ISSUES WERE CHOSEN BASED ON WHICH WERE EASIEST TO IDENTIFY AND HAD THE MOST REALISTIC LEVEL OF ACHIEVING. JAMESTOWN REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 15E: REPORTING TO COLLECTION AGENCY. JAMESTOWN REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 19D: PATIENTS ARE BILLED THE NORMAL CHARGE AMOUNTS. WE DO OFFER A 20% DISCOUNT FOR PROMPT PAYMENT IF THE PATIENT DOES A PRIVATE PAY (SUCH AS CASH, CHECK OR CREDIT CARD). PART VI, LINE 2: JAMESTOWN REGIONAL MEDICAL CENTER HAS PARTNERED WITH CENTRAL VALLEY HEALTH AND OTHER LOCAL AGENCIES AND DEVELOPED A COMMUNITY HEALTH ASSESSMENT FOR THE 5 COUNTIES, STUTSMAN, BARNES, LOGAN, WELLS AND LAMOURE, SERVED BY CENTRAL VALLEY HEALTH AND JAMESTOWN REGIONAL MEDICAL CENTER. THIS ROLE WAS A PART OF THE HOSPITAL'S 5 YEAR STRATEGIC PLAN. PART VI, LINE 3: ALL PATIENTS RECEIVE A "PAYMENT GUIDELINES" BROCHURE AT TIME OF REGISTRATION, WHICH NOTIFIES THE PATIENTS ON HOW TO APPLY FOR CHARITY CARE AS WELL AS EXPLAINS THE CLAIM FILING PROCESS, RESPONSIBLE PARTY, CO-PAYS AND PAYMENTS. ALL PRIVATE PAY PATIENTS RECEIVE A LETTER WHICH LISTS CHARITY CARE AS A PAYMENT ALTERNATIVE TO THOSE WHO QUALIFY. OUR WEBSITE CONTAINS A CHARITY LINK WHICH EXPLAINS THE PROGRAM AND ALLOWS FORMS TO BE DOWNLOADED AND PRINTED. PART VI, LINE 4: JAMESTOWN REGIONAL MEDICAL CENTER SERVES A NINE COUNTY AREA OF SOUTH CENTRAL NORTH DAKOTA. THE PRIMARY INDUSTRY IS AGRICULTURE. THE POPULATION IS 52,155 WITH 21% OVER THE AGE OF 65. THE AVERAGE AGE IS 42. MALE AND FEMALE POPULATION IS SPLIT EVENLY. AVERAGE INCOME BY HOUSEHOLD IS $53,650. THERE ARE TWO COLLEGES WITHIN JAMESTOWN REGIONAL MEDICAL CENTER TRADE AREA. JAMESTOWN REGIONAL MEDICAL CENTER IS THE ONLY BIRTHING CENTER WITHIN IN A 90 MILE RADIUS. PART VI, LINE 5: A MAJORITY OF THE GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF JAMESTOWN REGIONAL MEDICAL CENTER, NOR FAMILY MEMBERS THEREOF. JAMESTOWN REGIONAL MEDICAL CENTER EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OF ITS DEPARTMENTS. JAMESTOWN REGIONAL MEDICAL CENTER HAS COMPLETED CONSTRUCTION ON A REPLACEMENT HOSPITAL WHICH WILL HAVE MANY UPGRADES IN TECHNOLOGY, MOST OF WHICH ARE RELATED TO IMPROVING PATIENT CARE. PART VI, LINE 6: N/A 1 X X 0 0 0 0 0 0 0 0 0 MARTIN RICHMAN 1111-123111 194351 0 0 0 0 0 20717 0 12624 0 227692 0 0 0 ALAN O'NEIL 151128 0 0 0 0 0 14739 0 5935 0 171802 0 0 0 DR ALFONSO FINDLEY 550492 0 0 0 0 0 22678 0 17957 0 591127 0 0 0 DR PHILIP JYSTAD 303573 0 0 0 0 0 28203 0 9204 0 340980 0 0 0 DR SCOTT GOECKE 304842 0 0 0 0 0 22678 0 10327 0 337847 0 0 0 DR MANUEL HARRIS 238456 0 0 0 0 0 26766 0 11464 0 276686 0 0 0 DR EUGENE MEAD 237221 0 0 0 0 0 0 0 4979 0 242200 0 0 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 ORTHOPEDIC DEPARTMENT - JAMESTOWN REGIONAL MEDICAL CENTER HAS 1 ORTHOPEDIC SURGEON SPECIALIZING IN KNEE ARTHROSCOPY, FRACTURE REPAIR, AND TOTAL JOINT REPLACEMENT. THE ORTHOPEDIC DEPARTMENT ALSO SERVES AS JAMESTOWN'S SPORTS MEDICINE TEAM AND PARTNERS WITH THE LOCAL HIGH SCHOOL TO PROVIDE SERVICES SUCH AS PROACTIVE PREVENTION OF ATHLETIC INJURIES, ADVISE COACHES IN STRENGTH AND CONDITIONING, AND DESIGN AND SUPERVISE REHABILITATION PROGRAMS FOR ATHLETIC INJURIES. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION AMENDED THE BYLAWS IN SEVERAL AREAS. THERE WERE CHANGES IN CONTENT INCLUDING THE MISSION STATEMENT, VISION STATEMENT, THE "DOING BUSINESS AS" NAME, LOCATION OF THE BUSINESS AND SOME CORE VALUES. THE PREAMBLE WAS SHORTENED AND THERE WAS A NON-DISCRIMINATION STATEMENT ADDED. IN ADDITION, THERE WERE AMENDMENTS TO BYLAWS IN THE TEXT REGARDING MEETINGS. NOW THE NOTICE FOR MEETINGS SHALL BE 7 DAYS FOR REGULAR MEETINGS AND 24 HOURS FOR SPECIAL MEETINGS OR WHEN MEMBERS NOT PRESENT, WAIVE NOTICE. THERE IS NO LONGER A PROVISION THAT THE CEO MAY BE A MEMBER OF THE BOARD. CEO WILL BE AN EX OFFICIO MEMBER OF THE BOARD. THE DUTIES AND RESPONSIBILITIES OF CEO ARE NO LONGER INCLUDED IN THE BYLAWS. AS WELL THERE WERE PROVISIONS REMOVED, THERE IS NO LONGER A PROVISION FOR LAST TERM IF MEMBER BECOMES AGE 70 DURING TERM. THE TREASURER NO LONGER HAS CUSTODY OF ALL THE FUNDS OF THE CORPORATION. ALSO, THERE IS NO LONGER A PROVISION FOR THE HOSPICE SERVICE. THERE WERE ALSO ADDITIONS TO RULES FOR THE BOARD AND MEMBERS. NEW LANGUAGE STATES THAT REGULAR MEETINGS SHALL BE HELD AT LEAST QUARTERLY RATHER THAN MONTHLY. A MEMBER MAY BE REMOVED AT ANY TIME FOR FAILURE TO ATTEND 3 CONSECUTIVE BOARD MEETINGS WITHOUT SATISFACTORY EXCUSE OR PURSUING OBJECTIVES INCONSISTENT WITH JAMESTOWN REGIONAL MEDICAL CENTER. ALSO, THE BOARD CAN NOW TAKE ACTION WITHOUT A MEETING UNDER CERTAIN CONDITIONS. FORM 990, PART VI, SECTION B, LINE 11 THE PREPARER OF FORM 990 EMAILS A COPY OF THE FINAL 990 TO THE ORGANIZATION'S CHIEF FINANCIAL OFFICER. THE CHIEF FINANCIAL OFFICER PERFORMS A DETAIL REVIEW OF FORM 990. THE CHIEF FINANCIAL OFFICER PROVIDES EACH VOTING BOARD MEMBER WITH A COPY OF FORM 990 BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS ARE ASKED AT EVERY BOARD MEETING WHETHER OR NOT ANYONE HAS A DUALITY OF INTEREST OR CONFLICT OF INTEREST. DIRECTORS HAVING A DUALITY OF INTEREST OR A POSSIBLE CONFLICT OF INTEREST ON ANY MATTER WHICH COMES BEFORE THE BOARD SHALL NOT VOTE ON THE MATTER OR USE THEIR PERSONAL INFLUENCE ON THE MATTER. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE OF DUALITY OR CONFLICT OF INTEREST WAS MADE, AND THE DIRECTOR MAKING SUCH A DISCLOSURE SHALL NOT BE COUNTED IN DECLARING A QUORUM FOR THE DETERMINATION OF THE MATTER. THIS PROVISION SHALL NOT BE CONSTRUED AS PREVENTING THE DIRECTOR FROM BRIEFLY STATING A POSITION ON THE MATTER NOR FROM ANSWERING PERTINENT QUESTIONS. FORM 990, PART VI, SECTION B, LINE 15 FOR THE CEO, THE BOARD CHAIRMAN CONVERSES WITH AN HR CONSULTANT ON MARKET WAGES AND EVALUATION PROCESS. EVALUATION FORMS ARE TYPICALLY COMPLETED BY BOARD MEMBERS AND THE BOARD CHAIRMAN CONDUCTS THE ACTUAL EVALUATION. COMPARABILITY DATA WAS USED BY THOSE WITHOUT CONFLICT AND THE DECISIONS WERE DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. PRIOR YEAR 990S CAN BE OBTAINED BY REQUEST OR THROUGH GUIDESTAR. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -44,969. FORM 990, PART XII, LINE 2C THE CHIEF FINANCIAL OFFICER ASSUMES OVERSIGHT OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS. THE BOARD OF DIRECTORS WITH THE CHIEF FINANCIAL OFFICER ASSUME RESPONSIBILITY FOR SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR. JAMESTOWN REGIONAL MEDICAL CENTER FOUNDATION INC 2422 20TH ST SW JAMESTOWN ND 58401 363348763 FUNDRAISING ND 501(C)(3) LINE 11A, I LUTHERAN CHARITY ASSOCIATION 1 0 0 1 0 1 0 0 0 0 0 0 0 1 1 0 1 0 0 JAMESTOWN HOSPITAL FOUNDATION INC C 1212687 COST-AFFILIATED ORGANIZATION JAMESTOWN HOSPITAL FOUNDATION INC E 46000000 COST-AFFILIATED ORGANIZATION JAMESTOWN HOSPITAL FOUNDATION INC P 207952 COST-AFFILIATED ORGANIZATION