GLENCOE REGIONAL HEALTH SERVICES: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- GLENCOE REGIONAL HEALTH SERVICES (EIN 41-1949230)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-09-27
- IRS object ID
- 201202719349300515
- Schema version
- 2011v1.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-09-27T11:32:52-05:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | 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 | LARSONALLEN 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 | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411949230 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GLENCOE REGIONAL HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GLEN | NameControl |
| Phone | 3208643121 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1805 HENNEPIN AVENUE NORTH | AddressLine1 |
| City | GLENCOE | City |
| State | MN | State |
| ZIP Code | 553361416 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JEANNE CONKEL | Name |
| Title | BOARD CHAIR | Title |
| Phone | 3208643121 | Phone |
| Date Signed | 2012-09-17 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ROBERT E SCHILE | Name |
| PTIN | P00369682 | PTIN |
| Phone | 6123764500 | Phone |
| Date Prepared | 2012-09-17 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JON BRABAND | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1805 HENNEPIN AVENUE NORTH | AddressLine1 |
| City | GLENCOE | City |
| State | MN | State |
| ZIP Code | 553361416 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 57275448 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.GRHSONLINE.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1999 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE HIGH QUALITY, CONVENIENT AND PERSONAL HEALTH CARE TO THOSE WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 4 | NbrIndependentVotingMembers |
| Total Nbr Employees | 656 | TotalNbrEmployees |
| Total Nbr Volunteers | 130 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 375430 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 75532 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 48763734 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 48316797 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 518905 | InvestmentIncomePriorYear |
| Investment Income Current Year | 741680 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 227889 | OtherRevenuePriorYear |
| Other Revenue Current Year | 215926 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 49885958 | TotalRevenuePriorYear |
| Total Revenue Current Year | 49349935 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 15103 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 30214 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 29311037 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 29236745 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 17585658 | OtherExpensePriorYear |
| Other Expenses Current Year | 17653594 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 46911798 | TotalExpensesPriorYear |
| Total Expenses Current Year | 46920553 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2974160 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2429382 | RevenuesLessExpensesCY |
| Total Assets BOY | 74499893 | TotalAssetsBOY |
| Total Assets EOY | 75814953 | TotalAssetsEOY |
| Total Liabilities BOY | 29087110 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 28496553 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 45412783 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 47318400 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | GLENCOE REGIONAL HEALTH SERVICES EXISTS TO PROVIDE HIGH QUALITY, CONVENIENT AND PERSONAL HEALTH CARE TO THOSE WE SERVE. WE DO SO BY PROVIDING COMPREHENSIVE, EVIDENCE-BASED, COST-EFFECTIVE HEALTH CARE SERVICES AND EDUCATION. WE COLLABORATE WITH OTHERS TO COORDINATE AND IMPROVE THE HEALTH OF OUR COMMUNITIES, AND COMMIT OUR SKILLS AND RESOURCES TO BENEFIT THE WHOLE PERSON THROUGH ALL STAGES OF LIFE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 35802205 | Expense |
| Grants | 30214 | Grants |
| Revenue | 41164597 | Revenue |
| Description | HOSPITAL - THE FACILITY IS LICENSED FOR 49 BEDS. MEDICAL/SURGICAL SERVICES ARE PROVIDED FOR ACUTE AND SWING BED PATIENTS. MAJOR SERVICES PROVIDED INCLUDE ER, MEDICAL IMAGING, SURGERY, LABORATORY, REHABILITATION THERAPY AND CLINIC SERVICES. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 5866408 | Expense |
| Grants | 0 | Grants |
| Revenue | 6745068 | Revenue |
| Description | NURSING HOME - THE LONG-TERM CARE UNIT IS A 110-BED SKILLED NURSING FACILITY, WITH ALL BEDS MEDICARE AND MEDICAID CERTIFIED. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 402048 | Expense |
| Grants | 0 | Grants |
| Revenue | 462266 | Revenue |
| Description | INDEPENDENT SENIOR LIVING - ORCHARD ESTATES IS A 40-UNIT SENIOR-HOUSING COMPLEX COMPRISED OF ONE AND TWO BEDROOM APARTMENTS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 42070661 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 1 | 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 | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| 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 | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 27 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 656 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| 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 | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 4 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | 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 | 0 | 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 | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | 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 | CHERYL TRIPPEL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3208647758 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1805 HENNEPIN AVENUE NORTH | AddressLine1 |
| City | GLENCOE | City |
| State | MN | State |
| ZIP Code | 553361416 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| JEFF GRANT | ||||||||
| CHAIR | 0.50 | X | X | 1000 | 0 | 0 | ||
| DR DOUG WAGONER | ||||||||
| VICE CHAIR & PHYSICIAN | 40.50 | X | X | 269528 | 0 | 28070 | ||
| JIM WATERS | ||||||||
| SECRETARY | 0.50 | X | X | 1100 | 0 | 0 | ||
| DR JOHN BERGSENG | ||||||||
| DIRECTOR & PHYSICIAN | 40.50 | X | 444535 | 0 | 28070 | |||
| CAROL HAUKOS | ||||||||
| DIRECTOR | 0.50 | X | 800 | 0 | 0 | |||
| DR BRYAN PETERSEN | ||||||||
| DIRECTOR & PHYSICIAN | 40.50 | X | 302426 | 0 | 33216 | |||
| JEANNE CONKEL | ||||||||
| DIRECTOR | 0.50 | X | 1000 | 0 | 0 | |||
| JAN BRATSCH | ||||||||
| DIRECTOR | 0.50 | X | 1000 | 0 | 0 | |||
| JON BRABAND | ||||||||
| PRESIDENT & CEO | 40.00 | X | 200985 | 0 | 41290 | |||
| JOHN DOIDGE | ||||||||
| VP OF FINANCE | 40.00 | X | 145886 | 0 | 25284 | |||
| DR PREMAN SINGH | ||||||||
| PHYSICIAN | 40.00 | 404128 | 0 | 9412 | X | |||
| DR JOHN MARK JOHNSON | ||||||||
| PHYSICIAN | 40.00 | 371867 | 0 | 33002 | X | |||
| DR CHAD ROBBINS | ||||||||
| PHYSICIAN | 40.00 | 356860 | 0 | 32609 | X | |||
| DR ROBERT ZAJAC | ||||||||
| PHYSICIAN | 40.00 | 354363 | 0 | 33123 | X | |||
| DR WILLIAM PHILLIPS | ||||||||
| PHYSICIAN | 40.00 | 257519 | 0 | 24447 | X | |||
| DR KRISTINE KNUDTEN | ||||||||
| PHYSICIAN & FORMER HIGHEST COMPENSATED | 40.00 | 256703 | 0 | 31431 | X | |||
| DR PETER SMYTH | ||||||||
| PHYSICIAN & FORMER DIRECTOR | 40.00 | 224164 | 0 | 19766 | X | |||
| ROBERT LARTER | ||||||||
| CRNA & FORMER HIGHEST COMPENSATED | 40.00 | 241359 | 0 | 16147 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3835223 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 355867 | TotalOtherCompensation |
| Number Individuals GT100 K | 29 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | 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 |
|---|---|---|---|---|---|
| SHARED MEDICAL SERVICES | |||||
| PO BOX 330 | COTTAGE GROVE | WI | 53527 | MRI SERVICES | 282070 |
| SCHATZ CONSTRUCTION INC | |||||
| 1011 ARMSTRONG AVENUE | GLENCOE | MN | 55336 | CONSTRUCTION | 238026 |
| PARK NICOLLETMETHODIST HOSPITAL | |||||
| PO BOX 16300 | ST LOUIS PARK | MN | 55416 | MANAGEMENT FEES | 234250 |
| QUEST DIAGNOSTICS | |||||
| PO BOX 12989 | CHICAGO | IL | 60693 | REFERENCE LAB | 217945 |
| ALLINA HOSPITALS & CLINICS | |||||
| PO BOX 9383 NW7710 | MINNEAPOLIS | MN | 55440 | ECHO FEES | 213266 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 12 | NumberOfContractorsGT100K |
| Government Grants | 56095 | GovernmentGrants |
| All Other Contributions | 19437 | AllOtherContributions |
| Total Contributions | 75532 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| HOSPITAL | 623000 | 41164597 | 41164597 |
| NURSING HOME | 623000 | 6745068 | 6745068 |
| SENIOR LIVING | 623990 | 462266 | 462266 |
| OTHER PROGRAM REVENUES | 623000 | 40347 | 40347 |
| EQUITY INVEST. INCOME | 623000 | -95481 | -95481 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 48316797 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 552349 | TotalRevenueColumn |
| Exclusion | $552,349 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 6208 | 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 | 6208 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6208 | TotalRevenueColumn |
| Exclusion | $6,208 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 8080269 | Securities |
| Other | 34575 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 7825238 | Securities |
| Other | 100275 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 255031 | Securities |
| Other | -65700 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 189331 | TotalRevenueColumn |
| Exclusion | $189,331 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFETERIA REVENUE | 722210 | 173732 | $173,732 |
| MISCELLANEOUS | 900099 | 35986 | $35,986 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 209718 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 49349935 | TotalRevenueColumn |
| Related Or Exempt Function Income | 48316797 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $957,606 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30214 | Total |
| Program Services | 30214 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1524190 | Total |
| Program Services | 1091104 | ProgramServices |
| Management And General | 433086 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21781753 | Total |
| Program Services | 20828408 | ProgramServices |
| Management And General | 953345 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 773462 | Total |
| Program Services | 736173 | ProgramServices |
| Management And General | 37289 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3670443 | Total |
| Program Services | 3526248 | ProgramServices |
| Management And General | 144195 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1486897 | Total |
| Program Services | 1402885 | ProgramServices |
| Management And General | 84012 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7038 | Total |
| Management And General | 7038 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35448 | Total |
| Management And General | 35448 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2478486 | Total |
| Program Services | 1840988 | ProgramServices |
| Management And General | 637498 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 225702 | Total |
| Program Services | 2758 | ProgramServices |
| Management And General | 222944 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1254618 | Total |
| Program Services | 1027604 | ProgramServices |
| Management And General | 227014 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 153483 | Total |
| Management And General | 153483 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1073427 | Total |
| Program Services | 1072303 | ProgramServices |
| Management And General | 1124 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 185348 | Total |
| Program Services | 154177 | ProgramServices |
| Management And General | 31171 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9304 | Total |
| Management And General | 9304 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1197602 | Total |
| Program Services | 1197602 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3045977 | Total |
| Program Services | 3045977 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 797310 | Total |
| Program Services | 237233 | ProgramServices |
| Management And General | 560077 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL EXPENSES | 3041916 | 3041801 | 115 |
| LICENSES & TAXES | 1259652 | 78174 | 1181478 |
| DRUGS | 1126977 | 1120299 | 6678 |
| BAD DEBT EXPENSE | 834473 | 834473 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 926833 | Total |
| Program Services | 802240 | ProgramServices |
| Management And General | 124593 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46920553 | Total |
| Program Services | 42070661 | ProgramServices |
| Management And General | 4849892 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8434552 | BOY |
| EOY | 9992661 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23661926 | BOY |
| EOY | 22338071 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6543268 | BOY |
| EOY | 7131264 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 287019 | BOY |
| EOY | 300216 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 569518 | BOY |
| EOY | 867956 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 56789631 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 34130693 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23976665 | BOY |
| EOY | 22658938 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9235291 | BOY |
| EOY | 10799695 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 911598 | BOY |
| EOY | 816117 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 371068 | BOY |
| EOY | 345383 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 508988 | BOY |
| EOY | 564652 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 74499893 | BOY |
| EOY | 75814953 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3607651 | BOY |
| EOY | 3664533 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24938681 | BOY |
| EOY | 24239425 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31790 | BOY |
| EOY | 27943 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 508988 | BOY |
| EOY | 564652 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29087110 | BOY |
| EOY | 28496553 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45412783 | BOY |
| EOY | 47318400 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45412783 | BOY |
| EOY | 47318400 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 74499893 | BOY |
| EOY | 75814953 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2429382 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -523765 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 1 | GrantsOtherOrganizations |
| Grants Other Organizations | $2,327 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 0 | OtherActivities |
| Total Lobbying Expenditures IIB | 2327 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF OTHER LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1I: | ReturnReference |
| Explanation | LOBBYING PORTION OF ASSOCIATION DUES PAID TO AHA AND MHA. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtc |
| Included On FS | 1 | IncludedOnFS |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1221121 | OtherCostOrOtherBasis |
| Book Value | 1221121 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 37891103 | OtherCostOrOtherBasis |
| Depreciation | 21051532 | Depreciation |
| Book Value | 16839571 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1372434 | OtherCostOrOtherBasis |
| Depreciation | 998502 | Depreciation |
| Book Value | 373932 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 15850856 | OtherCostOrOtherBasis |
| Depreciation | 11857550 | Depreciation |
| Book Value | 3993306 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 454117 | OtherCostOrOtherBasis |
| Depreciation | 223109 | Depreciation |
| Book Value | 231008 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 22658938 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DEFERRED COMPENSATION | Description |
| Amount | $564,652 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 564652 | TotalOfAmounts |
| Total Revenue | 49349935 | TotalRevenue |
| Total Expenses | 46920553 | TotalExpenses |
| Excess Or Deficit For Year | 2429382 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -523765 | NetUnrealizedGLOnInvestments |
| Total Adjustments | -523765 | TotalAdjustments |
| Excess Or Deficit Per FS | 1905617 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 48591308 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -523765 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | -523765 | RevenueNotRptdF990 |
| Revenue Subtotal | 49115073 | RevenueSubtotal |
| Other Revenues Not Included | 234862 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 234862 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 49349935 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 46920553 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 46920553 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 46920553 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART IV, LINE 2B: | INDEPENDENT SENIOR LIVING TENANTS MAKE SECURITY DEPOSITS WHEN THEY MOVE IN TO THE FACILITY. DEPOSITS, WITH INTEREST, LESS ANY COSTS OF REPAIRS, ARE RETURNED TO TENANTS OR THEIR ESTATES WHEN THE TENANT LEAVES THE FACILITY. THE ORGANIZATION HOLDS SMALL AMOUNTS DEPOSITED BY RESIDENTS OF THE NURSING HOME ON THEIR BEHALF. RESIDENTS MAY MAKE DEPOSITS OR WITHDRAWALS AT ANY TIME. | |
| PART X: | THE FACILITY QUALIFIES AS A TAX-EXEMPT ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE FACILITY IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(C)(3) OF THE CODE. THE FACILITY HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE FACILITY FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. THE FACILITY'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. THE TAX RETURNS FOR THE YEARS 2008 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: |
| UNRESTRICTED CONTRIBUTIONS AND GRANT 63,032. INVESTMENT INCOME 278,318. EQUITY IN INCOME OF AFFILIATED ORGANIZATION -95,481. RENTAL PROPERTY 6,208. MISCELLANEOUS 48,485. LOSS ON DISPOSAL OF ASSETS -65,700. | PART XII, LINE 4B - OTHER ADJUSTMENTS: |
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 |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| 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 | 957899 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 957899 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02080 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8547272 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6059134 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2488138 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05400 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9505171 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6059134 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3446037 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07480 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 243675 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 25531 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 218144 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00470 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 112032 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 112032 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00240 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 50299 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 43113 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7186 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 97393 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 97393 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00210 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 503399 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 68644 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 434755 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00940 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10008570 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6127778 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3880792 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08420 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 11662 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 11662 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 5899 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 5899 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 17561 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 17561 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $839,127 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 8693084 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 10981141 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -2288057 | 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 | 1 | 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 | GLENCOE REGIONAL HEALTH SERVICES | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1805 HENNEPIN AVENUE NORTH | AddressLine1 |
| City | GLENCOE | City |
| State | MN | State |
| ZIP Code | 55336 | 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 | NURSING HOME/SNF | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GLENCOE REGIONAL HEALTH SERVICES | 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 | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| GLENCOE REGIONAL HEALTH SERVICES | ||||
| 1024 CENTRAL AVENUE | LESTER PRAIRIE | MN | 55354 | CLINIC |
| GLENCOE REGIONAL HEALTH SERVICES | ||||
| 300 BOWMAN STREET | STEWART | MN | 55385 | CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 7: THE AMOUNTS IN PART I, LINE 7 WERE CALCULATED USING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 IN THE IRS INSTRUCTIONS TO FORM 990, SCHEDULE H. | |
| PART I, LINE 7G: THE ORGANIZATION DID NOT INCLUDE ANY COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC IN ITS SUBSIDIZED HEALTH SERVICES IN SCHEDULE H, PART I, LINE 7G. | |
| PART I, L7 COL(F): BAD DEBT EXPENSE REPORTED IN FORM 990, PART IX, LINE 24D WERE $834,473. THIS AMOUNT WAS SUBTRACTED IN CALCULATING THE PERCENTAGES IN SCHEDULE H, PART I, LINE 7, COLUMN F. | |
| PART II: OUR COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF OUR COMMUNITIES THROUGH DISASTER PREPAREDNESS EFFORTS, CASE MANAGEMENT OF UNDERINSURED AND UNINSURED PATIENTS, FINANCIAL AND IN-KIND SUPPORT, AND EDUCATION. FIRST, THROUGH DISASTER PREPAREDNESS TRAINING, WE SUPPORT AND PROTECT THE HEALTH OF OUR COMMUNITIES BY WORKING TO INSURE THAT THOSE NEEDING MEDICAL ATTENTION CAN ACCESS QUALITY CARE IN A SAFE AND TIMELY MANNER. DISASTER PREPAREDNESS EFFORTS ARE A YEAR-ROUND ACTIVITY, AS DISASTERS CAN INCLUDE PANDEMICS, NATURAL DISASTERS AND MASS CASUALTY SITUATIONS. SECOND, BY PROVIDING CASE MANAGEMENT OF UNDERINSURED AND UNINSURED PATIENTS, WE WORK TO HELP PATIENTS RETURN HOME AND REGAIN THEIR INDEPENDENCE AFTER AN ILLNESS, INJURY OR SURGERY. IN CASES WHERE IT IS NOT POSSIBLE FOR SOMEONE TO RETURN HOME, WE WORK TO MAKE SURE THEY HAVE ACCESS TO THE CARE AND RESOURCES THEY NEED TO CONTINUE THEIR RECOVERY OR LIVE WITH DIGNITY. THROUGH HELPING OUR PATIENTS OBTAIN FINANCIAL SUPPORT, AS WELL AS OBTAIN ACCESS TO COMMUNITY SUPPORT SYSTEMS, WE WORK TO ENSURE THAT THEY GET ADDITIONAL SERVICES THAT MAY BE NEEDED TO ASSIST IN THEIR RECOVERY. THIS PROMOTES THE HEALTH OF THE COMMUNITY BY INSURING THAT PATIENTS HAVE THE SUPPORT AND RESOURCES THEY NEED TO RETURN TO THE COMMUNITY AS PRODUCTIVE CITIZENS, AS WELL HELPING TO CREATE A COMMUNITY IN WHICH PEOPLE ARE VALUED AND TREATED WITH RESPECT. THIRD, BY PROVIDING FINANCIAL AND IN-KIND SUPPORT TO THE GLENCOE AREA CHAMBER OF COMMERCE, WE SUPPORT THE ECONOMIC HEALTH OF OUR REGION. A STRONG LOCAL ECONOMY CONTRIBUTES TO THE OVERALL HEALTH AND WELL-BEING OF ALL ITS RESIDENTS. BY PROVIDING FINANCIAL AND IN-KIND SUPPORT FOR COMMUNITY ACTIVITIES, SUCH AS THE MCLEOD COUNTY FOOD DRIVE CHALLENGE, WE ENHANCE THE QUALITY OF LIFE IN OUR COMMUNITY. FINALLY, BY PROVIDING EDUCATIONAL PRESENTATIONS AND TOURS TO OUR AREA SCHOOLS, WE ARE INVESTING IN A FUTURE GENERATION OF HEALTH CARE WORKERS WHO MAY SOMEDAY PROVIDE DIRECT CARE TO OUR PATIENTS AND OTHERS IN THE COMMUNITIES WE SERVE. WE ARE ALSO EDUCATING INDIVIDUALS ABOUT THE WORK WE DO, WHY WE DO IT, AND HOW OUR EFFORTS AFFECT THEIR LIVES AND THE LIVES OF OTHERS. | |
| PART III, LINE 4: THE FACILITY PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON MANAGEMENT'S JUDGMENT. PATIENTS AND RESIDENTS ARE NOT REQUIRED TO PROVIDE COLLATERAL FOR SERVICES PROVIDED. PAYMENT FOR SERVICES IS REQUIRED WITHIN 30 DAYS OF RECEIPT OF INVOICE. PAST DUE ACCOUNTS ARE INDIVIDUALLY ANALYZED FOR COLLECTIBILITY AND FINANCIAL ASSISTANCE. IF NO OTHER OPTIONS EXIST THEY ARE THEN TURNED OVER TO COLLECTION AGENTS. ACCOUNTS FOR WHICH NO PAYMENTS HAVE BEEN RECEIVED ARE ANALYZED AND AFTER APPROVAL ARE WRITTEN OFF. IN ADDITION, AN ALLOWANCE IS ESTIMATED FOR OTHER ACCOUNTS BASED ON HISTORICAL EXPERIENCE OF THE FACILITY.BAD DEBT EXPENSE (AT COST) IS CALCULATED BY APPLYING THE COST-TO-CHARGE RATIO TO THE TOTAL BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS. | |
| PART III, LINE 8: THE ORGANIZATION USES A COST-TO-CHARGE RATIO TO CALCULATE THE MEDICARE ALLOWABLE COSTS REPORTED IN ITS MEDICARE COST REPORT. THE ORGANIZATION USES THE MEDICARE REIMBURSEMENT PROVIDER MANUAL 15-2 TO DETERMINE ACCEPTABLE METHODOLOGIES. | |
| PART III, LINE 9B: OUR GENERAL DEBT COLLECTION POLICY FOR ALL PATIENTS IS AS FOLLOWS: TWO BILLING STATEMENTS ARE SENT OUT TO THE PATIENT. ACCOUNTS WITH NO SELF-PAY ACTIVITY WITHIN TWO MONTHS RECEIVE A FIRST REMINDER LETTER. IF NO PAYMENT IS RECEIVED WITHIN ONE MONTH OF THE FIRST REMINDER LETTER, A SECOND REMINDER IS SENT. IF NO PAYMENT IS MADE WITHIN THREE WEEKS OF THE SECOND LETTER BEING SENT, A PHONE CALL IS PLACED TO THE PATIENT IN ORDER TO SET UP PAYMENT ARRANGEMENTS. IF AN AGREEMENT IS NOT MET THE ACCOUNT IS SENT TO COLLECTIONS. IN ALL, PATIENTS RECEIVE FOUR NOTICES BEFORE AN ACCOUNT IS SENT TO COLLECTIONS. PAYMENT PLANS ARE AVAILABLE TO ALL PATIENTS REGARDLESS OF INSURANCE COVERAGE OR FINANCIAL SITUATION. WE DO NOT CHARGE INTEREST OR FEES ON PAYMENT PLANS. FOR 2011, THERE WAS A MINIMUM $50.00 PAYMENT REQUIRED ON PAYMENT PLANS.IF PATIENTS CONTACT US ABOUT THEIR BILL, WE WILL REFER THEM TO FINANCIAL ASSISTANCE PROGRAMS THAT ARE AVAILABLE OR DETERMINE IF THEY ARE ELIGIBLE FOR CHARITY CARE PROGRAMS OR UNINSURED DISCOUNT PROGRAMS. INFORMATION ABOUT THE DISCOUNTS AND PROGRAMS THAT ARE AVAILABLE TO PATIENTS CAN ALSO BE FOUND ON THE BACK OF EACH MONTHLY STATEMENT AND ON EACH PAYMENT REMINDER LETTER THAT IS SENT. WHEN INSURANCE COMPANIES NEED MORE INFORMATION FROM THE PATIENT TO PROCESS THE CLAIM, WE WILL CALL THE PATIENT AND SEND THE PATIENT A REMINDER LETTER ASKING THE PATIENT TO CONTACT THEIR INSURANCE COMPANY. | |
| PART V, SECTION B, LINE 9: 1 PERSON-$22,340 OR UNDER, 2 PEOPLE, $30,260 OR UNDER, 3 PEOPLE-$38,180 OR UNDER, 4 PEOPLE-$46,100 OR UNDER, 5 PEOPLE-$54,020 OR UNDER, 6 PEOPLE-$61,940 OR UNDER, 7 PEOPLE-$69,860 OR UNDER, 8 PEOPLE-$77,780 OR UNDER. FOR FAMILY UNITS WITH MORE THAN 8 MEMBERS, ADD $3,960 FOR EACH ADDITIONAL MEMBER. | GLENCOE REGIONAL HEALTH SERVICES |
| PART V, SECTION B, LINE 10: PEOPLE WHO EARN MORE THAN THE POVERTY LEVEL LISTED ABOVE, BUT NOT MORE THAN 2 TIMES THE FEDERAL POVERTY LEVEL, ARE OFFERED A DISCOUNT CALCULATED BY TAKING THE FAMILY INCOME MINUS THE POVERTY LEVEL AND THEN DIVIDE THAT NUMBER BY THE POVERTY LEVEL. THAT IS THE PORTION THAT THE PATIENT WOULD BE RESPONSIBILE FOR. | GLENCOE REGIONAL HEALTH SERVICES |
| PART V, SECTION B, LINE 19D: MAXIMUM AMOUNT CHARGED IS THE NEGOTIATED RATE FROM THE HOSPITAL'S LARGEST COMMERCIAL INSURANCE CARRIER. | GLENCOE REGIONAL HEALTH SERVICES |
| PART VI, LINE 2: GRHS ASSESSES OUR COMMUNITIES' HEALTH NEEDS THROUGH VARIOUS METHODS. WE HAVE CONDUCTED COMMUNITY-BASED RESEARCH ON SEVERAL OCCASIONS, INCLUDING USE OF FOCUS GROUPS AND STATISTICALLY VALID TELEPHONIC SURVEYS. DURING OUR ANNUAL STRATEGIC PLANNING PROCESS, WE REVIEW UTILIZATION TRENDS, ALONG WITH THE RESULTS OF ANY COMMUNITY-BASED RESEARCH CONDUCTED THAT YEAR. WE SOLICIT FEEDBACK FROM OUR MEDICAL STAFF REGARDING ISSUES AND TRENDS THEY SEE. WE VERIFY THOSE TRENDS, AS WELL AS IDENTIFY OTHER ISSUES AND NEEDS BY CONDUCTING INTERNAL RESEARCH AND REVIEWS OF PATIENT DATA AND STATISTICS. WE ALSO MONITOR FEEDBACK RECEIVED THROUGH PATIENT SATISFACTION SURVEYS. IN ADDITION, WE SURVEY OUR PATIENTS AT ALL OF OUR COMMUNITY HEALTH EVENTS TO FIND OUT WHAT TOPICS THEY WOULD LIKE TO KNOW MORE ABOUT. WE ALSO COLLABORATE WITH LOCAL PUBLIC HEALTH AND OTHER AGENCIES AS APPROPRIATE TO LEARN ABOUT OUR COMMUNITIES' NEEDS. | |
| PART VI, LINE 3: GRHS EDUCATES AND INFORMS PATIENTS ABOUT FINANCIAL ASSISTANCE, CHARITY CARE AND UNINSURED DISCOUNT PROGRAMS IN ALL BILLING INVOICES SENT. THE INFORMATION IS LISTED ON THE BACK OF THE BILLING STATEMENT. WE ALSO POST THE INFORMATION IN OUR FACILITY AND INCLUDE IT ON OUR WEB SITE, WWW.GRHSONLINE.ORG. IN ADDITION, WE PROVIDE A REPORT BACK TO THE COMMUNITY ANNUALLY ABOUT OUR FINANCES AND CHARITY CARE AMOUNTS. THIS REPORT IS SENT TO ALL OF OUR PATIENTS, AS WELL AS THE RESIDENTS IN THE COMMUNITIES WE SERVE. | |
| PART VI, LINE 4: PATIENTS CARED FOR BY GRHS RESIDE, PRIMARILY, IN AN AREA WITHIN A RADIUS OF TWENTY MILES OF THE CITY OF GLENCOE, WHICH IS APPROXIMATELY 55 MILES WEST OF MINNEAPOLIS. IN THE 12-MONTH PERIOD JANUARY - DECEMBER 2011, 41.5% OF THE INPATIENTS ADMITTED TO GRHS RESIDED IN GLENCOE, AND ANOTHER 48.5% OF THE INPATIENTS ADMITTED RESIDED WITHIN TWENTY MILES OF GLENCOE (FOR A TOTAL OF 90.0%). IN 2000, IT WAS ESTIMATED THAT THE POPULATION OF THE GRHS SERVICE AREA WAS 39,224. IN 2012, IT IS ESTIMATED TO BE 40,878, AN INCREASE OF 4.2% IN THIS 12-YEAR PERIOD. | |
| PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | EMPLOYEE SCHOLARSHIPS | TypeOfGrant |
| Number Of Recipients | 15 | NumberOfRecipients |
| Amount Of Cash Grant | 20114 | AmountOfCashGrant |
| Method Of Valuation | COST | MethodOfValuation |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: GLENCOE REGIONAL HEALTH SERVICES PROVIDES TUITION REIMBURSEMENT ASSISTANCE TO EMPLOYEES. EMPLOYEES ARE REQUIRED TO COMPLETE THE REIMBURSEMENT REQUEST FORM, WHICH IS TO BE SIGNED BY THEIR SUPERVISOR, PRIOR TO BEGINNING THEIR COURSE(S) TO RESERVE FUNDS. THEY ARE TO INCLUDE A DESCRIPTION OF THE COURSE(S) THEY PLAN TO TAKE, AND RECEIPTS FOR TUITION AND BOOKS, (FEES ARE NOT ELIGIBLE FOR REIMBURSEMENT), WITH THEIR REQUEST. EMPLOYEES ARE REQUIRED TO COMPLETE THEIR COURSE WITH A GRADE OF C OR BETTER TO BE ELIGIBLE FOR REIMBURSEMENT. EMPLOYEES ARE RESPONSIBLE FOR ALL UP-FRONT COSTS. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | 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 II Form990ScheduleJPartII (13 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR DOUG WAGONER | |||||||||||||
| 258357 | 0 | 10371 | 0 | 800 | 0 | 0 | 0 | 28070 | 0 | 297598 | 0 | 0 | 0 |
| DR JOHN BERGSENG | |||||||||||||
| 425453 | 0 | 18082 | 0 | 1000 | 0 | 0 | 0 | 28070 | 0 | 472605 | 0 | 0 | 0 |
| DR BRYAN PETERSEN | |||||||||||||
| 291282 | 0 | 10044 | 0 | 1100 | 0 | 0 | 0 | 33216 | 0 | 335642 | 0 | 0 | 0 |
| JON BRABAND | |||||||||||||
| 179622 | 0 | 21363 | 0 | 0 | 0 | 0 | 0 | 41290 | 0 | 242275 | 0 | 0 | 0 |
| JOHN DOIDGE | |||||||||||||
| 139089 | 0 | 6797 | 0 | 0 | 0 | 6797 | 0 | 18487 | 0 | 171170 | 0 | 0 | 0 |
| DR PREMAN SINGH | |||||||||||||
| 390839 | 0 | 13289 | 0 | 0 | 0 | 0 | 0 | 9412 | 0 | 413540 | 0 | 0 | 0 |
| DR JOHN MARK JOHNSON | |||||||||||||
| 353258 | 0 | 15009 | 0 | 3600 | 0 | 0 | 0 | 33002 | 0 | 404869 | 0 | 0 | 0 |
| DR CHAD ROBBINS | |||||||||||||
| 334950 | 0 | 15910 | 0 | 6000 | 0 | 0 | 0 | 32609 | 0 | 389469 | 0 | 0 | 0 |
| DR ROBERT ZAJAC | |||||||||||||
| 330251 | 0 | 16512 | 0 | 7600 | 0 | 0 | 0 | 33123 | 0 | 387486 | 0 | 0 | 0 |
| DR WILLIAM PHILLIPS | |||||||||||||
| 251021 | 0 | 6498 | 0 | 0 | 0 | 0 | 0 | 24447 | 0 | 281966 | 0 | 0 | 0 |
| DR KRISTINE KNUDTEN | |||||||||||||
| 241329 | 0 | 11774 | 0 | 3600 | 0 | 0 | 0 | 31431 | 0 | 288134 | 0 | 0 | 0 |
| DR PETER SMYTH | |||||||||||||
| 210026 | 0 | 8138 | 0 | 6000 | 0 | 0 | 0 | 19766 | 0 | 243930 | 0 | 0 | 0 |
| ROBERT LARTER | |||||||||||||
| 241359 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 16147 | 0 | 257506 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 4B | JOHN DOIDGE - 457(B) PLAN - $16,500 ROBERT LARTER (CRNA) - 457(B) PLAN - $16,500 | |
| PART III | JON BRABAND (CEO) IS EMPLOYED BY PARK NICOLLET, AN UNRELATED THIRD PARTY. HE OPERATES AS CEO OF GLENCOE REGIONAL HEALTH SERVICES UNDER A MANAGEMENT CONTRACT WITH PARK NICOLLET. AS SUCH, HIS COMPENSATION IS REPORTED ON FORM 990, PART VII AND ON SCHEDULE J, PART II. | SUPPLEMENTAL INFORMATION |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF GLENCOE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 416005185 | IssuerEIN |
| CUSIP Number | 378160BF1 | CUSIPNumber |
| Date Issued | 2005-08-18 | DateIssued |
| Issue Price | 25440900 | IssuePrice |
| Description Of Purpose | DEFEASE PART OF 2001 REV. BONDS & FUND EXPANSION OF MEDICAL/SURGICAL UNIT. | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amount Retired | 1865900 | AmountRetired |
| Total Proceeds | 25499173 | TotalProceeds |
| Amount In Reserve Fund | 353688 | AmountInReserveFund |
| Refunding Escrow | 19021387 | RefundingEscrow |
| Issuance Costs From Proceeds | 466682 | IssuanceCostsFromProceeds |
| Capital Expenditures | 5709899 | CapitalExpenditures |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 1 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | 1 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 0 | ExceptionToRebate |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THERE SHALL BE AN EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS WHICH SHALL CONSIST OF THE CHAIRPERSON OF THE BOARD OF DIRECTORS, THE VICE CHAIRPERSON OF THE BOARD, THE PRESIDENT AND THE SECRETARY OF THE BOARD OF DIRECTORS. THE CHAIRPERSON OF THE BOARD OF DIRECTORS SHALL BE THE CHAIRPERSON OF THE EXECUTIVE COMMITTEE AND THE SECRETARY SHALL ACT AS THE SECRETARY THEREOF. THE EXECUTIVE COMMITTEE SHALL ADVISE WITH AND AID THE OFFICERS OF THE CORPORATION IN ALL MATTERS CONCERNING THE MANAGEMENT OF ITS BUSINESS; AND BETWEEN MEETINGS OF DIRECTORS THE EXECUTIVE COMMITTEE SHALL POSSESS AND MAY EXERCISE ALL OF THE POWERS OF THE BOARD OF DIRECTORS EXCEPT WITH REFERENCE TO MAKING OR AMENDING THE BYLAWS FOR THE BOARD OF DIRECTORS, REMOVING ANY MEMBER OF THE BOARD OF DIRECTORS OR FILLING VACANCIES IN THEIR OWN MEMBERSHIP. | |
| FORM 990, PART VI, SECTION A, LINE 3 | THE ORGANIZATION HAS A CONTRACTUAL ARRANGEMENT WITH PARK NICOLLET HEALTH SERVICES, UNDER WHICH PARK NICOLLET HEALTH SERVICES PROVIDES A CHIEF EXECUTIVE OFFICER, MANAGEMENT CONSULTATION, AND OTHER SERVICES TO THE FACILITY. THE ARRANGEMENT DOES NOT ALTER THE AUTHORITY OR RESPONSIBILITY OF THE BOARD OF DIRECTORS OF GLENCOE REGIONAL HEALTH SERVICES. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 REPORT WAS REVIEWED WITH THE BOARD MEMBERS AT A REGULARY SCHEDULED BOARD MEETING. THE BOARD WAS ASKED TO APPROVE THE DOCUMENT PRIOR TO SUBMISSION TO THE IRS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | GLENCOE REGIONAL HEALTH SERVICES HAS A CONFLICT OF INTEREST POLICY THAT APPLIES TO ALL MEMBERS OF THE BOARD OF DIRECTORS, MEMBERS OF A COMMITTEE OF THE BOARD OF DIRECTORS, AND SENIOR MANAGEMENT. ANNUALLY, THE BOARD MEMBERS AND SENIOR MANAGMENT ARE ASKED TO COMPLETE THE CONFLICT OF INTEREST DECLARATION. ANY INDIVIDUAL HAVING A CONFLICT OF INTEREST IS REQUIRED TO INFORM THE BOARD OR COMMITTEE. THE INDIVIDUAL ABSTAINS FROM VOTING ON THE MATTER, BUT IS PERMITTED TO BRIEFLY STATE THEIR POSITION AND ANSWER PERTINENT QUESTIONS. THE MINUTES OF THE MEETING REFLECT THAT THE DISCLOSURE WAS MADE AND THAT THE PERSON ABSTAINED FROM VOTING. THE PRESIDENT AND CEO IS RESPONSIBLE FOR MONITORING CONFLICTS OF INTEREST. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO REVIEW PROCESS IS PERFORMED UNDER THE DIRECTION OF PARK NICOLLET AND INDEPENDENT COMPARISON DATA IS USED TO ESTABLISH COMPENSATION. THE BOARD OF DIRECTORS FINALIZES THE REVIEW AND COMPENSATION. THE VICE PRESIDENT OF FINANCE REVIEW IS CONDUCTED BY THE CEO AND COMPENSATION IS DETERMINED USING INDEPENDENT COMPARISON DATA. BOTH POSITIONS WERE REVIEWED IN 2011. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. ANNUAL FINANCIAL STATEMENTS ARE PUBLISHED ONCE PER YEAR IN THE FACILITY PUBLICATION TOUCHING LIVES. THE TOUCHING LIVES PUBLICATION IS MAILED TO ALL RESIDENTS IN THE FACILITY'S SERVICE AREA. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -523,765. | CHANGES IN NET ASSETS OR FUND BALANCES: |