INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSN: Form 990, tax year 2012
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- Organization
- INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSN (EIN 41-0726171)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-01
- IRS object ID
- 201303059349300905
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-01T10:33:33-05:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410746749 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410726171 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | INTE | NameControl |
| Phone | 2182835401 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MELISSA MARCOTTE | Name |
| Title | CFO | Title |
| Phone | 2182835401 | Phone |
| Date Signed | 2013-10-22 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DARRYN MCGARVEY | Name |
| PTIN | P00958683 | PTIN |
| Phone | 6123764500 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RAINY LAKE MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | BOB HALEY | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| 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 | 26004055 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.RAINYLAKEMEDICAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1945 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | TO PROMOTE AND PROVIDE HEALTH CARE AND WELLNESS SERVICES IN OUR REGION THAT EXCEED EXPECTATIONS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 216 | TotalNbrEmployees |
| Total Nbr Volunteers | 25 | TotalNbrVolunteers |
| Total Gross UBI | 14129 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 76573 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 88186 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 24425477 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 25195442 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 149080 | InvestmentIncomePriorYear |
| Investment Income Current Year | 102178 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 611203 | OtherRevenuePriorYear |
| Other Revenue Current Year | 583760 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 25262333 | TotalRevenuePriorYear |
| Total Revenue Current Year | 25969566 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10073101 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 9595663 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 9314 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 15724278 | OtherExpensePriorYear |
| Other Expenses Current Year | 16007657 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 25797379 | TotalExpensesPriorYear |
| Total Expenses Current Year | 25603320 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -535046 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 366246 | RevenuesLessExpensesCY |
| Total Assets BOY | 22089557 | TotalAssetsBOY |
| Total Assets EOY | 21869475 | TotalAssetsEOY |
| Total Liabilities BOY | 3195497 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2977792 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 18894060 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 18891683 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 19992610 | Expense |
| Grants | 0 | Grants |
| Revenue | 25195442 | Revenue |
| Description | PROVIDED HEALTH SERVICES TO THE COMMUNITY OF INTERNATIONAL FALLS. IN ADDITION TO PROVIDING DIRECT PATIENT CARE AND IN FURTHERANCE OF ITS CHARITABLE 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 FOR 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 2012,THERE WERE 8,169 EMERGENCY/URGENT CARE VISITS, 57 BIRTHS, 480 ACUTE CARE ADMISSIONS, AND 1,898 TOTAL PATIENT DAYS. | Description |
| Total Program Service Expense | 19992610 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 40 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 216 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MELISSA MARCOTTE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2182835431 | TelephoneNumber |
Address US AddressUS
| 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 Form990PartVIISectionA (22 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| CHARLES HELLELOID MD | ||||||||
| CHAIR/VICE CHAIR (THRU JANUARY 2012) | 4.00 | X | X | 0 | 0 | 0 | ||
| SUSAN CONGRAVE | ||||||||
| VICE CHAIR | 4.00 | X | X | 0 | 0 | 0 | ||
| BILL DOUGHERTY | ||||||||
| SECRETARY | 4.00 | X | X | 0 | 0 | 0 | 2.00 | |
| DON BILLIG | ||||||||
| TREASURER | 4.00 | X | X | 0 | 0 | 0 | ||
| ROBERT ANDERSON | ||||||||
| MEMBER/CHAIR (THRU JANUARY 2012) | 4.00 | X | X | 0 | 0 | 0 | ||
| JOSEPH BIANCO MD | ||||||||
| MEMBER | 4.00 | X | 0 | 0 | 0 | |||
| BONNIE ERICKSON | ||||||||
| MEMBER | 4.00 | X | 0 | 0 | 0 | |||
| JEFF HARDWIG MD | ||||||||
| MEMBER | 4.00 | X | 0 | 0 | 0 | |||
| NORMAN LARSEN | ||||||||
| MEMBER/SECRETARY (THRU JANUARY 2012) | 4.00 | X | X | 0 | 0 | 0 | ||
| MIKE MOTLEY | ||||||||
| MEMBER/TREASURER (THRU JANUARY 2012) | 4.00 | X | X | 0 | 0 | 0 | ||
| BRAD REINERS | ||||||||
| MEMBER | 4.00 | X | 0 | 0 | 0 | |||
| GAIL ROGNERUD | ||||||||
| MEMBER | 4.00 | X | 0 | 0 | 0 | 2.00 | ||
| ANTHONY STONE MD | ||||||||
| MEMBER | 4.00 | X | 0 | 0 | 0 | |||
| JON TALSNESS MD | ||||||||
| MEMBER | 4.00 | X | 0 | 0 | 0 | |||
| GARY BIGLER | ||||||||
| MEMBER | 4.00 | X | 0 | 0 | 0 | |||
| STEVE ERIXON | ||||||||
| INTERIM CEO (UNTIL MAY 2012) | 40.00 | X | 0 | 0 | 0 | 1.00 | ||
| BOB HALEY | ||||||||
| INTERIM CEO | 40.00 | X | 0 | 0 | 0 | 1.00 | ||
| VERA SCHUMANN | ||||||||
| CFO (UNTIL NOVEMBER 2012) | 40.00 | X | 0 | 0 | 0 | 1.00 | ||
| MELISSA MARCOTTE | ||||||||
| CFO | 40.00 | X | 72987 | 0 | 0 | 1.00 | ||
| KATIE CHEZICK | ||||||||
| DIRECTOR PHARMACY | 40.00 | 118149 | 0 | 8970 | X | |||
| DONITA ETTESTAD | ||||||||
| CNO | 40.00 | 102737 | 0 | 4295 | X | |||
| LORI CONSTANTINE | ||||||||
| DIRECTOR SURGICAL SERVICES | 40.00 | 101309 | 0 | 9469 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 395182 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 22734 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ESSENTIA HEALTHDULUTH CLINIC | |||||
| 400 EAST 3RD STREET | DULUTH | MN | 55805 | PROFESSIONAL & MANAGEMENT SERVICES FOR C | 3933269 |
| WAPITI MEDICAL GROUP | |||||
| PO BOX 92 | NEWELL | SD | 57760 | ER PHYSICIAN FEES | 1209649 |
| QUORUM HEALTH RESOURCES | |||||
| 105 CONTINENTAL PLACE | BRENTWOOD | TN | 37027 | MANAGEMENT SERVICES; CONTRACT CEO & CFO | 648639 |
| CMDI | |||||
| 150 10TH ST NW | MILACA | MN | 56353 | CT, ULTRASOUND AND MAMMOGRAPHY LEASE | 561086 |
| CPSI | |||||
| PO BOX 850309 | MOBILE | AL | 36685 | HOSPITAL-WIDE COMPUTER INFO. SYSTEM | 469029 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 16 | NumberOfContractorsGT100K |
| Related Organizations | 3759 | RelatedOrganizations |
| Government Grants | 8355 | GovernmentGrants |
| All Other Contributions | 76072 | AllOtherContributions |
| Total Contributions | 88186 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENUE | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 25195442 | TotalRevenueColumn |
| Related Or Exempt Function Income | 25181313 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 14129 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 25195442 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 96227 | TotalRevenueColumn |
| Exclusion | $96,227 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 29723 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 29723 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 29723 | TotalRevenueColumn |
| Exclusion | $29,723 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 40440 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 34489 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 5951 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5951 | TotalRevenueColumn |
| Exclusion | $5,951 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| MEANINGFUL USE REVENUE | 900099 | 272919 | $272,919 |
| CT SERVICES | 900099 | 207200 | $207,200 |
| OTHER REVENUE | 900099 | 73918 | $73,918 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 554037 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 25969566 | TotalRevenueColumn |
| Related Or Exempt Function Income | 25181313 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 14129 | UnrelatedBusinessRevenue |
| Exclusion | $685,938 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72987 | Total |
| Management And General | 72987 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7676965 | Total |
| Program Services | 5977059 | ProgramServices |
| Management And General | 1690592 | ManagementAndGeneral |
| Fundraising | 9314 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 296867 | Total |
| Program Services | 252307 | ProgramServices |
| Management And General | 44560 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 960286 | Total |
| Program Services | 813673 | ProgramServices |
| Management And General | 146613 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 588558 | Total |
| Program Services | 498699 | ProgramServices |
| Management And General | 89859 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 861371 | Total |
| Management And General | 861371 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 98839 | Total |
| Management And General | 98839 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17434 | Total |
| Management And General | 17434 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7219858 | Total |
| Program Services | 6595346 | ProgramServices |
| Management And General | 624512 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24509 | Total |
| Management And General | 24509 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 520434 | Total |
| Program Services | 343248 | ProgramServices |
| Management And General | 177186 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 497849 | Total |
| Program Services | 87567 | ProgramServices |
| Management And General | 410282 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 278188 | Total |
| Program Services | 273948 | ProgramServices |
| Management And General | 4240 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20677 | Total |
| Program Services | 10154 | ProgramServices |
| Management And General | 10523 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 734952 | Total |
| Program Services | 734952 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 86957 | Total |
| Management And General | 86957 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| CLINIC PATIENT SERVICES | 2978544 | 2978544 | |
| BAD DEBT EXPENSE | 1102467 | 1102467 | |
| TAXES AND SURCHARGES | 420835 | 420835 | |
| MEDICAL SUPPLIES | 324646 | 324646 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 820097 | Total |
| Management And General | 820097 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25603320 | Total |
| Program Services | 19992610 | ProgramServices |
| Management And General | 5601396 | ManagementAndGeneral |
| Fundraising | 9314 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11539547 | BOY |
| EOY | 11862717 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2820275 | BOY |
| EOY | 2922800 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 357501 | BOY |
| EOY | 355219 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 143574 | BOY |
| EOY | 122632 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 14147206 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 8444332 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6511783 | BOY |
| EOY | 5702874 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 716877 | BOY |
| EOY | 684233 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 219000 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22089557 | BOY |
| EOY | 21869475 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2444558 | BOY |
| EOY | 2659274 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 750939 | BOY |
| EOY | 318518 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3195497 | BOY |
| EOY | 2977792 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18872281 | BOY |
| EOY | 18891683 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21779 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18894060 | BOY |
| EOY | 18891683 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22089557 | BOY |
| EOY | 21869475 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 366246 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -368623 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 161319 | OtherCostOrOtherBasis |
| Book Value | 161319 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7471007 | OtherCostOrOtherBasis |
| Depreciation | 3199613 | Depreciation |
| Book Value | 4271394 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 156684 | OtherCostOrOtherBasis |
| Depreciation | 118960 | Depreciation |
| Book Value | 37724 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6219405 | OtherCostOrOtherBasis |
| Depreciation | 5125759 | Depreciation |
| Book Value | 1093646 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 138791 | OtherCostOrOtherBasis |
| Book Value | 138791 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 5702874 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO RELATED PARTY | Description |
| Amount | $318,518 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 318518 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | THE CENTER IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE THAT IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(C)(3) OF THE CODE. 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 2010 TO 2012 ARE OPEN TO EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 127436 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 127436 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00500 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4549171 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3225541 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1323630 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05170 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4676607 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3225541 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1451066 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05670 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8059 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 8059 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 22046 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 22046 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3102 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3102 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 33207 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 33207 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00130 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4709814 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3225541 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1484273 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05800 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 10885 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 10885 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Environmental Improvements EnvironmentalImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 25334 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 25334 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 36219 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 36219 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,102,467 | BadDebtExpenseAmount |
| Amount Attributable To | 90362 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 8344724 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 8144428 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 200296 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 0 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RAINY LAKE MEDICAL CENTER | BusinessNameLine1 |
Address Address
| 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) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | PROVIDER-BASED CLINIC | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RAINY LAKE MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Other Actions Taken | X | OtherActionsTaken |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| 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 I, L7 COL(F): BAD DEBT EXPENSE OF $1,102,467 WAS SUBTRACTED WHEN CALCULATING THE COMMUNITY BENEFIT EXPENSE AS A PERCENT OF TOTAL EXPENSE. | |
| PART II: 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 4: 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.TAKEN FROM FOOTNOTE 1 "PATIENTS ACCOUNTS RECEIVABLE, NET" ON PAGE 8: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE CENTER ANALYZES ITS PAST HISTORY 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. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS 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 CENTER RECORDS A 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. | |
| PART III, LINE 8: THERE WAS NO SHORTFALL CALCULATED IN 2012. THE AMOUNTS INCLUDED IN PART III, LINES 6-8 WERE DERIVED USING THE 2012 FILED MEDICARE COST REPORT. | |
| PART III, LINE 9B: RLMC'S POLICY STATES THAT A PATIENT'S ACCOUNT WILL NOT BE REFERRED TO COLLECTION UNLESS THE PATIENT HAS BEEN GIVEN REASONABLE OPPORTUNITY TO SUBMIT AN APPLICATION FOR THE COMMUNITY CARE PROGRAM IF THE FACTS AND CIRCUMSTANCES SUGGEST THE PATIENT MAY BE ELIGIBLE FOR COMMUNITY CARE. | |
| PART V, SECTION B, LINE 14G: ON BILLING STATEMENTS IT IS STATED TO CONTACT PATIENT FINANCIAL COUNCELOR FOR COMMUNITY CARE OR OTHER FINANCIAL ASSISTANCE. INCLUDES CONTACT PHONE NUMBER. | RAINY LAKE MEDICAL CENTER |
| PART V, SECTION B, LINE 18E: RLMC WORKS WITH PATIENTS TO SET UP PAYMENT PLANS AND/OR IDENTIFY OTHER FINANCIAL ASSISTANCE SUCH AS MEDICAID. RLMC IS A MNCAA FACILITY THAT EMPLOYS 3 CERTIFIED STAFF MEMBERS. | RAINY LAKE MEDICAL CENTER |
| PART V, SECTION B, LINE 20D: RLMC CALCULATES AMOUNTS GENERALLY BILLED BASED ON THEIR MOST FAVORED PROVIDER. RLMC DIVIDES ALL PAYMENTS BY ALL CHARGES OVER THE PRIOR 13 MONTHS TO DETERMINE THE AVERAGE DISCOUNT PROVIDED. THIS PROCEDURE IS REPEATED EVERY THREE MONTHS. THE CURRENT DISCOUNT IS 22%. THE LOWEST DISCOUNT GIVEN TO PATIENTS THAT QUALIFY UNDER RLMC'S FINANCIAL ASSISTANCE POLICY IS 25%. | RAINY LAKE MEDICAL CENTER |
| PART VI, LINE 2: A GOAL OF THE FIVE YEAR STRATEGIC PLAN IS TO "COMMIT TIME AND RESOURCES TO RESPONDING TO COMMUNITY NEEDS WHERE THEY FEEL THERE ARE GAPS IN SERVICE". THIS IS DONE WITH TACTICS INCLUDING CONDUCTING A MARKET ASSESSMENT OF SERVICE GAPS EVERY THREE YEARS, AS WELL AS ASSESSING THE NEED FOR A DIALYSIS UNIT, ALZHEIMER'S UNIT, AND VARIOUS OUTREACH SPECIALTIES. | |
| 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 J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | X | HousingAllowanceOrResidence |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Written Employment Contract | X | WrittenEmploymentContract |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 1A | ReturnReference |
| Explanation | BOB HALEY, INTERIM CEO, RECEIVED A HOUSING ALLOWANCE OF $7,200 TO COVER HIS MONTHLY RENT. THIS WAS NOT INCLUDED IN HIS TAXABLE COMPENSATION SINCE RLMC PAYS THIS DIRECTLY. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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, 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 CEO AND CFO (UNTIL NOVEMBER '12) ARE EMPLOYEES 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 MADE AVAILABLE UPON REQUEST. | |
| FORM 990, PART IX, LINE 11G | LICENSES AND DUES: PROGRAM SERVICE EXPENSES 130,766. MANAGEMENT AND GENERAL EXPENSES 63,410. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 194,176. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 5,038,146. MANAGEMENT AND GENERAL EXPENSES 222,069. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,260,215. CONTRACTED/PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,426,434. MANAGEMENT AND GENERAL EXPENSES 312,498. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,738,932. PUBLIC RELATIONS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 4,351. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,351. SERVICE CHARGES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 22,184. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,184. | OTHER FEES |
| FORM 990, PART XI, LINE 9: | CHANGE IN RECOGNIZED PENSION COSTS -321,078. CHANGE IN INTEREST IN FOUNDATION -47,545. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FALLS MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1 |
Address US AddressUS
| 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 | PrimaryActivities |
| Legal Domicile State | MN | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 11A, I | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | 1 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |