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LUTHERAN CHARITY ASSOCIATION: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
LUTHERAN CHARITY ASSOCIATION (EIN 45-0231181)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-04-30
IRS object ID
201241219349300909
Schema version
2010v3.4
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

FieldValueIRS element (for citing)
Timestamp2012-04-30T15:24:19-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1WIPFLI LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line17601 FRANCE AVENUE SOUTH SUITE 400AddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55435ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN450231181EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1LUTHERAN CHARITY ASSOCIATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlLUTHNameControl
Phone7012521050Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1419 FIFTH STREET NEAddressLine1
CityJAMESTOWNCity
StateNDState
ZIP Code584013360ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameALAN O'NEILName
TitleCHIEF FINANCIAL OFFICERTitle
Phone7012521050Phone
Date Signed2012-04-24DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameRICHARD RUVELSONName
Phone9525483400Phone
Date Prepared2012-04-24DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1JAMESTOWN HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonALAN O'NEILNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1419 FIFTH STREET NEAddressLine1
CityJAMESTOWNCity
StateNDState
ZIP Code584013360ZIPCode
FieldValueIRS element (for citing)
Gross Receipts28628546GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.JAMESTOWNHOSPITAL.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1927YearFormation
State Legal DomicileNDStateLegalDomicile
Activity Or Mission DescriptionTO COMPASSIONATELY REVOLUTIONIZE HEALTHCARE IN THE HEARTLAND.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees358TotalNbrEmployees
Total Nbr Volunteers112TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year268792ContributionsGrantsPriorYear
Contributions Grants Current Year1488870ContributionsGrantsCurrentYear
Program Service Revenue Prior Year26067323ProgramServiceRevenuePriorYear
Program Service Revenue CY26333441ProgramServiceRevenueCY
Investment Income Prior Year579952InvestmentIncomePriorYear
Investment Income Current Year474773InvestmentIncomeCurrentYear
Other Revenue Prior Year136601OtherRevenuePriorYear
Other Revenue Current Year331462OtherRevenueCurrentYear
Total Revenue Prior Year27052668TotalRevenuePriorYear
Total Revenue Current Year28628546TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year15087385SalariesEtcPriorYear
Salaries Etc Current Year15714644SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year10379634OtherExpensePriorYear
Other Expenses Current Year10885898OtherExpensesCurrentYear
Total Expenses Prior Year25467019TotalExpensesPriorYear
Total Expenses Current Year26600542TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1585649RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2028004RevenuesLessExpensesCY
Total Assets BOY49713952TotalAssetsBOY
Total Assets EOY73203276TotalAssetsEOY
Total Liabilities BOY25725131TotalLiabilitiesBOY
Total Liabilities EOY46902922TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY23988821NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY26300354NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionPROVIDE HEALTH CARE SERVICES TO JAMESTOWN AND THE SURROUNDING AREA.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense22872134Expense
Revenue26664903Revenue
DescriptionJAMESTOWN REGIONAL MEDICAL CENTER IS A 25 BED CRITICAL ACCESS HOSPITAL PROVIDING SHORT-TERM ACUTE INPATIENT, OUTPATIENT, SWING BED, HOME HEALTH AND HOSPICE HEALTH CARE SERVICES. THE NEAREST PROVIDER OF HEALTH CARE SERVICES IS MORE THEN 35 MILES AWAY AND JAMESTOWN REGIONAL MEDICAL CENTER IS LOCATED 100 MILES AWAY FROM THE NEAREST MAJOR HEALTH SERVICE CENTERS IN FARGO OR BISMARCK, NORTH DAKOTA. WE ALSO PROVIDE SPACE FOR A SATELLITE DIALYSIS UNIT OPERATED BY MEDCENTER ONE, BISMARCK, NORTH DAKOTA. JAMESTOWN REGIONAL MEDICAL CENTER MAKES MEDICAL CARE ACCESSIBLE TO THE ENTIRE COMMUNITY IT SERVES. IN ADDITION TO THE ROUTINE INPATIENT AND OUTPATIENT HEALTH CARE SERVICES WE PROVIDE THE FOLLOWING SPECIALTY SERVICES TO THE COMMUNITIES WE SERVE:* CARDIAC CARE AND REHABILITATION: IN ADDITION TO EMERGENCY AND INTENSIVE CARE UNITS OUR CARDIAC SERVICES INCLUDE CARDIOLITE STRESS, ADENOSCAN AND ADENOWALK CARDIOLITE IMAGING TESTS AND SPECT IMAGING TESTS FOR ACCURATE DIAGNOSIS; AND MONITORED DIET AND EXERCISE PROGRAMS THROUGHOUT THE HOSPITAL STAY AND THROUGH OUTPATIENT CARE IN OUR CARDIAC REHABILITATION CENTER.* MAMMOGRAPHY: OUR MAMMOGRAPHY UNIT WAS DESIGNED FOR WOMEN AND IS STAFFED BY FEMALE PROFESSIONALS. * EMERGENCY CARE: OUR EMERGENCY CENTER IS STAFFED 24 HOURS A DAY THROUGHOUT THE YEAR AND HANDLES EVERYTHING FROM BROKEN BONES TO HEART ATTACKS.* HOME HEALTH SERVICES: SERVICES PROVIDED TO THE HOME BOUND INCLUDE NURSING, PHYSICAL, OCCUPATIONAL, SPEECH AND SOCIAL SERVICES.* HOSPICE: PROVIDE FOR THE PHYSICAL AND PSYCHOLOGICAL NEEDS OF THE TERMINALLY ILL AND HELP ACCOMODATE THEIR FAMILIES THROUGH A FULL RANGE OF HOSPICE SERVICES.* NUTRITIONAL COUNSELING: OUR REGISTERED DIETITIANS PROVIDE NUTRITIONAL ASSESSMENTS AND PERSONALIZED DIET PLANS TO OPTIMIZE HEALTH AND SPEED RECOVERY THROUGH PROPER NUTRITION.* PHYSICAL AND OCCUPATIONAL THERAPY: PROVIDE A FULL RANGE OF SERVICES TO HELP PATIENTS RECOVER FROM ON-THE-JOB, SPORTS-RELATED INJURIES AND CERTAIN DEBILITATING DISEASES.* SOCIAL SERVICES AND SUPPORT GROUPS: OUR FACILITY PROVIDES A WIDE RANGE OF SUPPORT IN THE COORDINATION OF SERVICES BY OUR SOCIAL SERVICE DEPARTMENT AND SUPPORT GROUPS TO HELP OUR PATIENTS AND THEIR FAMILIES COPE WITH THE EMOTIONAL AND FINANCIAL EFFECTS OF ILLNESS.* PODIATRY SERVICES: OUR LICENSED AND CREDENTIALED DOCTOR OF PODIATRY MEDICINE TREATS EVERYTHING FROM FLAT FEET TO BUNIONS WITH MODERATE THERAPEUTIC TECHNIQUES.* SPEECH AND HEARING SERVICES: WE EMPLOY LICENSED AUDIOLOGIST AND SPEECH THERAPISTS THAT CAN HELP CORRECT HEARING LOSS AND SPEECH DIFFICULTIES.* SURGERY CENTER: OUR INPATIENT AND OUTPATIENT SURGERY CENTER IS CAPABLE OF HANDLING A WIDE VARIETY OF GENERAL AND SPECIALIZED SURGICAL PROCEDURES INCLUDING LAPAROSCOPIC AND CATARACT PROCEDURES.* WELLNESS PROGRAMS: OUR WELLNESS CENTER OFFERS THE COMMUNITY A FULL SCHEDULE OF CLASSES ON SUBJECTS RANGING FROM HEALTHY DIET, FITNESS AND PREVENTATIVE CARE ALONG WITH A FULLY EQUIPPED FITNESS CENTER TO HELP THE PEOPLE WE SERVE LEARN HOW TO MODIFY THEIR LIFESTYLES FOR A HEALTHIER LIFE.* OTHER SUPPORT SERVICES:* LABORATORY, PATHOLOGY AND RADIOLOGY SERVICES: FULL RANGE OF SERVICES TO PROVIDE ACCURATE DIAGNOSIS FOR TREATMENT* MEDICAL LIBRARY: VIDEO, WRITTEN AND ONLINE MATERIALS TO HELP KEEP OUR STAFF UP-TO-DATE AND AS A RESOURCE FOR OUR COMMUNITY.* CARE LINE: WE OPERATE AN EMERGENCY RESPONSE TELEPHONE BASED RESPONSE CENTER TO ENABLE THE FRAIL ELDERLY TO REMAIN INDEPENDENT IN THEIR HOMES.* VOLUNTEERS AND VOLUNTEER SERVICES: WE HAVE, ON THE AVERAGE, 112 COMMUNITY VOLUNTEERS PROVIDING APPROXIMATELY 6,435 HOURS OF SERVICE TO THE HOSPITAL AND THE PATIENTS WE SERVE. SOME OF THE MANY AREAS THEY PROVIDE SERVICES ARE AS FOLLOWS:* SENIOR COMPANIONS: HELPING SENIOR CITIZENS MAINTAIN INDEPENDENCE BY READING TO THEM, HELPING WITH SHOPPING, ETC.* HOSPICE: ASSISTING HOSPICE PATIENTS AND FAMILIES COPE WITH TERMINAL ILLNESS.* CHILDREN'S TLC: VOLUNTEERS PROVIDE PARENTS WITH A BREAK WITH THEIR CHILDREN THAT ARE HOSPITALIZED.* TELECARE: MAINTAIN CONTACT WITH YOUR FRIENDS OR FAMILY MEMBER THROUGH TELEPHONE CALLS TO THEIR HOME.* GIFT SHOPPE: OPERATED FOR THE CONVENIENCE OF FRIENDS AND FAMILY OF HOSPITAL PATIENTS TO OBTAIN CARDS, FLOWERS AND SMALL GIFTS FOR PATIENTS IN OUR FACILITY. * CARING TOUCH: A PARTNERSHIP WITH JAMESTOWN COLLEGE TO PROVIDE SUPPORT OF PATIENTS BOTH IN THE HOSPITAL AND AFTER THEY RETURN HOME.* OTHER SERVICES: COMMUNITY MEMBERS VOLUNTEER THEIR SERVICES TO HELP OUT IN TIMES OF NEED IN MOST SERVICE AREAS ASSISTING PATIENTS AND THEIR FAMILIES. SERVICES PROVIDED DURING FYE JUNE 30, 2011:*4,241 INPATIENT DAYS OF WHICH 184 WERE SWING BED AND 9 HOSPICE DAYS OF CARE* 41% MEDICARE IS THE PERCENTAGE OF INPATIENT DAYS* 17.7% MEDICAID IS THE PERCENTAGE OF INPATIENT DAYS* 7,921 EMERGENCY VISITS OF WHICH 769 RESULTED IN INPATIENT ADMISSIONS* 26,111 TOTAL OUTPATIENT VISITS* 2,357 OUTPATIENT SURGICAL PROCEDURE VISITS INCLUDING OUTPATIENT SURGERY AND SCOPES* 305 LIVE BIRTHS* 1,720 CARDIAC REHAB VISITS* 4,868 HOME HEALTH VISITS* 3,426 HOSPICE DAYS OF CARE* 5,147 DIALYSIS TREATMENTS* $369,709 IN FREE CARE* 112 VOLUNTEERS PROVIDED 6,435 HOURS OF VOLUNTEER SERVICE.IN SUMMARY, JAMESTOWN HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL, GEOGRAPHICALLY LOCATED IN RURAL SOUTH-CENTRAL NORTH DAKOTA. THE CLOSEST MEDICAL FACILITY IS MORE THAN 35 MILES AWAY AND THE CLOSEST COMPARABLE MEDICAL SERVICES ARE 100 MILES FROM JAMESTOWN.Description
Total Program Service Expense22872134TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109631NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees358NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ALAN O'NEILBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7019524802TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1419 FIFTH STREET NEAddressLine1
CityJAMESTOWNCity
StateNDState
ZIP Code584013360ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (17 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
HARVEY HUBER
CHAIRPERSON1.00XX000
CONNIE KRAPP
VICE CHAIRPERSON1.00XX000
REV TERRY ANDERSON
SECRETARY1.00XX000
JOANNE OTTMAR
TREASURER1.00XX000
ERIC MONSON MD
BOARD MEMBER1.00X000
SHANDA TRAISER PH D
BOARD MEMBER1.00X000
DEBRA GEIR MD
BOARD MEMBER1.00X000
DR JAMES R TORRANCE MD
BOARD MEMBER1.00X000
DENNIS D POZARNSKY
BOARD MEMBER1.00X000
DAVID MATHISON MD
BOARD MEMBER1.00X000
MARTIN I RICHMAN
CEO40.00X185516033637
ALAN O'NEIL
CFO40.00X146629018549
DR ALFONSO FINDLEY
RADIOLOGIST40.00646352014460X
DR PHILIP JYSTAD
PHYSICIAN40.00285005052018X
DR MANUEL HARRIS
PODIATRIST40.00246045050532X
DR SCOTT GOECKE
PHYSICIAN40.00227872011710X
KATHRYN KOVAR
PHARMACIST40.00145515015772X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1882934TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation196678TotalOtherCompensation
Number Individuals GT100 K15NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
AMERISOURCE BERGEN
PO BOX 959VALLEY FORGEPA19482PHARMACEUTICAL SERVICES893775
NATIONAL MEDICAL RESOURCES INC
2900 E BROADWAY AVE SUITE 1BISMARCKND58501ER PHYSICIANS828309
OWENS & MINOR
2151 COUNTY ROAD H2 WESTMOUNDS VIEWMN55112MEDICAL-SURGICAL SERVICES571486
IMAGING SOLUTIONS INC
2829 UNIVERSITY DRIVE SFARGOND58103DIAGNOSTIC IMAGING SERVICES446034
HEALTHCARE MANAGEMENT SYSTEMS
3102 WEST END AVE SUITE 400NASHVILLETN37203SOFTWARE SERVICES266109
FieldValueIRS element (for citing)
Number Of Contractors GT100 K19NumberOfContractorsGT100K
Related Organizations650000RelatedOrganizations
All Other Contributions838870AllOtherContributions
Total Contributions1488870TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE RE6214002582358325823583
WELLNESS/LIFELINE/CARE900099183406183406
RENTAL INCOME531120115338115338
CONSULTATION SERVICES5419008795887958
ER COVERAGE REIMBURSEM5419005913759137

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column64019TotalRevenueColumn
Related Or Exempt Function Income64019RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue26333441TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column268001TotalRevenueColumn
Exclusion$268,001ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities206272Securities
Other500Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities206272Securities
Other500Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column206772TotalRevenueColumn
Exclusion$206,772ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
CAFETERIA900099170149$170,149
OTHER REVENUE900099127243127243
GIFT SHOP SALES45322029598$29,598

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column4472TotalRevenueColumn
Exclusion$4,472ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue331462TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column28628546TotalRevenueColumn
Related Or Exempt Function Income26460684RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$678,992ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total397869Total
Management And General397869ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total12407589Total
Program Services10960823ProgramServices
Management And General1446766ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total787176Total
Program Services694180ProgramServices
Management And General92996ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1250086Total
Program Services1106995ProgramServices
Management And General143091ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total871924Total
Program Services773066ProgramServices
Management And General98858ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total58110Total
Management And General58110ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2231556Total
Program Services1826975ProgramServices
Management And General404581ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total189565Total
Program Services2279ProgramServices
Management And General187286ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2455241Total
Program Services2131319ProgramServices
Management And General323922ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total199615Total
Program Services43041ProgramServices
Management And General156574ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total547469Total
Program Services513890ProgramServices
Management And General33579ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total94893Total
Program Services74125ProgramServices
Management And General20768ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total80929Total
Program Services29877ProgramServices
Management And General51052ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total45461Total
Program Services45461ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1315937Total
Program Services1315937ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total173436Total
Program Services57304ProgramServices
Management And General116132ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
DRUG EXPENSE11695201169520
BAD DEBT EXPENSE10801291080129
OTHER EXPENSE939257742433196824
FOOD EXPENSE188878188878
BLOOD EXPENSE115902115902

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total26600542Total
Program Services22872134ProgramServices
Management And General3728408ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY113744BOY
EOY75395EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3467648BOY
EOY2527574EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3535085BOY
EOY3778667EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY436352BOY
EOY449477EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY187800BOY
EOY142271EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis77435884LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec24982353LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY21467397BOY
EOY52453531EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY5713653BOY
EOY7889978EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY1010137EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY14792273BOY
EOY4876246EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY49713952BOY
EOY73203276EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5580201BOY
EOY8810377EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY1555000BOY
EOY790000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY18039626BOY
EOY36960699EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY550304BOY
EOY341846EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY25725131BOY
EOY46902922EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY23988821BOY
EOY26300354EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY23988821BOY
EOY26300354EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY49713952BOY
EOY73203276EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses2028004ReconcilationRevenueExpenses
Reconcilation Other Changes283529ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee0AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$5,836OtherActivitiesAmount
Total Lobbying Expenditures IIB5836TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF OTHER LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1I:ReturnReference
ExplanationTHE ORGANIZATION PAYS DUES TO VARIOUS PROFESSIONAL ORGANIZATIONS. A PORTION OF THOSE DUES ARE USED TOWARDS LOBBYING EXPENSES.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis691427OtherCostOrOtherBasis
Book Value691427BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis7618752OtherCostOrOtherBasis
Depreciation5501412Depreciation
Book Value2117340BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis23207148OtherCostOrOtherBasis
Depreciation19480941Depreciation
Book Value3726207BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis45918557OtherCostOrOtherBasis
Book Value45918557BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings52453531TotalOfBookValueLandBuildings

Other Assets OtherAssets (6 entries)

DescriptionDescriptionBook ValueBookValue
UNAMORTIZED DEBT ISSUE COSTS752378
RELATED PARTY RECEIVABLE162202
HEALTH SAVINGS FUND397373
BOND FUND2974229
BOND RESERVE479750
PROPERTY HELD FOR INVESTMENT AT COST110314
FieldValueIRS element (for citing)
Total Book Value Other Assets4876246TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionCAPITAL LEASE OBLIGATIONDescription
Amount$341,846Amount
FieldValueIRS element (for citing)
Total Of Amounts341846TotalOfAmounts
Total Revenue28628546TotalRevenue
Total Expenses26600542TotalExpenses
Excess Or Deficit For Year2028004ExcessOrDeficitForYear
Net Unrealized GL On Investments283529NetUnrealizedGLOnInvestments
Total Adjustments283529TotalAdjustments
Excess Or Deficit Per FS2311533ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt28912075TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments283529NetUnrealizedGainsInvestments
Revenue Not Rptd F990283529RevenueNotRptdF990
Revenue Subtotal28628546RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99028628546TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt26600542TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal26600542ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99026600542TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationIN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740-10, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, REQUIRES AN ORGANIZATION TO ASSESS WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT DOES NOT BELIEVE THE ORGANIZATION HAS ANY MATERIAL UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS. THE ORGANIZATION'S FEDERAL INFORMATIONAL RETURNS FOR TAX YEARS 2007 AND SUBSEQUENT YEARS REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense253243TotalCommunityBenefitExpense
Net Community Benefit Expense253243NetCommunityBenefitExpense
Percent Of Total Expense0.00990PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense2506386TotalCommunityBenefitExpense
Direct Offsetting Revenue2398051DirectOffsettingRevenue
Net Community Benefit Expense108335NetCommunityBenefitExpense
Percent Of Total Expense0.00420PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense2759629TotalCommunityBenefitExpense
Direct Offsetting Revenue2398051DirectOffsettingRevenue
Net Community Benefit Expense361578NetCommunityBenefitExpense
Percent Of Total Expense0.01410PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense2759629TotalCommunityBenefitExpense
Direct Offsetting Revenue2398051DirectOffsettingRevenue
Net Community Benefit Expense361578NetCommunityBenefitExpense
Percent Of Total Expense0.01410PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$739,866BadDebtExpenseAmount
Amount Attributable To330070AmountAttributableTo
Amount Reimbursed By Medicare8806294AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare8862646CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-56352MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1JAMESTOWN HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1419 5TH ST NEAddressLine1
CityJAMESTOWNCity
StateNDState
ZIP Code58401ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1JAMESTOWN HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)

ExplanationExplanation
PART I, LINE 7: THE COSTING METHODOLOGY IS THE COST TO CHARGES RATIO. DURING THE YEAR THERE WAS INCREASE IN SPECIFIC SERVICES, SUCH AS OB SERVICES, WHICH HAVE A HIGHER MEDICAID REIMBURSMENT RATE.
PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1080129.
PART II: JAMESTOWN HOSPITAL PROVIDES SEVERAL LOW COST EDUCATIONAL TRAINING SESSIONS AT THE HOSPITAL AND AT DIFFERENT LOCATIONS IN THE COMMUNITY. FOR EXAMPLE, JAMESTOWN HOSPITAL PROVIDES BREAST FEEDING, CAR SEAT TRAINING, PRENATAL TRAINING, AND HAPPIEST BABY ON THE BLOCK CLASSES. NEW YEAR NEW YOU FITNESS CHALLENGE WAS INTRODUCED IN 2008 TO ENCOURAGE AREA RESIDENTS TO MAKE POSITIVE LIFESTYLE CHANGES AND REDUCE THE RISK OF HEART DISEASE, DIABETES, OBESITY AND TOBACCO USE.
PART III, LINE 4: WE CALCULATED THE REASONABLE COST OF POSSIBLE ELIGIBLE CHARITY CARE THAT WENT TO BAD DEBT BY TAKING THE AVERAGE CLAIM PER GUARANTOR THAT QUALIFIED FOR CHARITY CARE TIMES THE GUARANTORS THAT TOOK APPLICATIONS AND DID NOT FOLLOW THROUGH ON THE PROCESS. THIS AMOUNT WAS BROUGHT DOWN TO COST BY TAKING THAT NUMBER TIMES THE RATIO OF PATIENT CARE COST TO CHARGES. THE CARRYING AMOUNTS OF PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE.
PART III, LINE 8: THE COSTING METHODOLOGY USED IS COST TO CHARGE RATIO AS REQUIRED BY MEDICARE. SHORTFALL IS NOT INDICATIVE OF ANY CHANGE IN COMMUNITY BENEFIT AS THE COSTING METHODOLOGY AND DETERMINATION OF ALLOWABLE COSTS HAVE NOT CHANGED FROM PRIOR YEAR.
PART III, LINE 9B: NO COLLECTIONS EFFORT WILL BE MADE BY JAMESTOWN HOSPITAL OR ITS COLLECTION AGENCIES ON THE PERCENTAGE OF COMMUNITY CARE APPROVED. HOWEVER, PATIENTS MUST HAVE COMPLETED THE COMMUNITY CARE APPLICATION PROCESS, ESTABLISH THEIR ELIGIBILITY, AND HAVE BEEN APPROVED. IF SUCH A PATIENT IS MISTAKENLY BILLED, HOSPITAL STAFF WILL APOLOGIZE FOR THE ERROR AND CORRECT THE MISTAKE.
PART VI, LINE 2: JAMESTOWN HOSPITAL HAS PARTNERED WITH CENTRAL VALLEY HEALTH AND OTHER LOCAL AGENCIES TO DEVELOP A COMMUNITY HEALTH ASSESSMENT FOR THE 5 COUNTIES, STUTSMAN, BARNES, LOGAN, WELLS AND LAMOURE, SERVED BY CENTRAL VALLEY HEALTH AND JAMESTOWN HOSPITAL. THIS ROLE IS PART OF THE HOSPITAL'S 5 YEAR STRATEGIC PLAN.
PART VI, LINE 3: ALL PATIENTS RECEIVE A "PAYMENT GUIDELINES" BROCHURE AT TIME OF REGISTRATION, WHICH NOTIFIES THE PATIENTS ON HOW TO APPLY FOR CHARITY CARE AS WELL AS EXPLAINS THE CLAIM FILING PROCESS, RESPONSIBLE PARTY, CO-PAYS AND PAYMENTS. ALL PRIVATE PAY PATIENTS RECEIVE A LETTER WHICH LISTS CHARITY CARE AS A PAYMENT ALTERNATIVE TO THOSE WHO QUALIFY. OUR WEBSITE CONTAINS A CHARITY LINK WHICH EXPLAINS THE PROGRAM AND ALLOWS FORMS TO BE DOWNLOADED AND PRINTED.
PART VI, LINE 4: JAMESTOWN HOSPITAL SERVES A NINE COUNTY AREA OF SOUTH CENTRAL NORTH DAKOTA. THE PRIMARY INDUSTRY IS AGRICULTURE. THE POPULATION IS 52,155 WITH 21% OVER THE AGE OF 65. THE AVERAGE AGE IS 42. MALE AND FEMALE POPULATION IS SPLIT EVENLY. AVERAGE INCOME BY HOUSEHOLD IS $53,650. THERE ARE TWO COLLEGES WITHIN JAMESTOWN HOSPITAL TRADE AREA. JAMESTOWN HOSPITAL IS THE ONLY BIRTHING CENTER WITHIN IN A 90 MILE RADIUS.
PART VI, LINE 6: A MAJORITY OF THE GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF JAMESTOWN HOSPITAL, NOR FAMILY MEMBERS THEREOF. JAMESTOWN HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OF ITS DEPARTMENTS. JAMESTOWN HOSPITAL IS IN THE PROCESS OF CONSTRUCTING A REPLACEMENT HOSPITAL WHICH WILL HAVE MANY UPGRADES IN TECHNOLOGY, MOST OF WHICH ARE RELATED TO IMPROVING PATIENT CARE.
PART VI, LINE 7: N/A

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MARTIN I RICHMAN
18551600000198540137830219153000
ALAN O'NEIL
1466290000012995055540165178000
DR ALFONSO FINDLEY
6463520000000144600660812000
DR PHILIP JYSTAD
28500500000274430245750337023000
DR MANUEL HARRIS
24604500000265630239690296577000
DR SCOTT GOECKE
2278720000000117100239582000
KATHRYN KOVAR
1455150000000157720161287000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 1AReturnReference
ExplanationBASED ON APPROPRIATENESS AND THE EXPECTATION THAT THE CEO HAVE A VOLUNTARY PRESENCE IN THE COMMUNITY, THE CEO IS AUTHORIZED TO HAVE SOME SOCIAL CLUB DUES PAID ON HIS/HER BEHALF BY THE HOSPITAL.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF JAMESTOWNBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN456002099IssuerEIN
Date Issued2003-06-26DateIssued
Issue Price5740000IssuePrice
Description Of PurposeREFUNDING PRIOR ISSUEDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Amount Retired4950000AmountRetired
Total Proceeds5740000TotalProceeds
Other Spent Proceeds5740000OtherSpentProceeds
Year Of Subst Completion2003YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Counsel Routinely Engaged0BondCounselRoutinelyEngaged
Post Issuance Compliance Procdrs0PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate1ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11THE PREPARER OF FORM 990 EMAILS A COPY OF THE FINAL 990 TO THE ORGANIZATION'S CHIEF FINANCIAL OFFICER. THE CHIEF FINANCIAL OFFICER PERFORMS A DETAIL REVIEW OF FORM 990. THE CHIEF FINANCIAL OFFICER PROVIDES EACH VOTING BOARD MEMBER WITH A COPY OF FORM 990 BEFORE IT IS FILED WITH THE IRS.
DIRECTORS ARE ASKED AT EVERY BOARD MEETING WHETHER OR NOT ANYONE HAS A DUALITY OF INTEREST OR CONFLICT OF INTEREST. DIRECTORS HAVING A DUALITY OF INTEREST OR A POSSIBLE CONFLICT OF INTEREST ON ANY MATTER WHICH COMES BEFORE THE BOARD SHALL NOT VOTE ON THE MATTER OR USE THEIR PERSONAL INFLUENCE ON THE MATTER. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE OF DUALITY OR CONFLICT OF INTEREST WAS MADE, AND THE DIRECTOR MAKING SUCH A DISCLOSURE SHALL NOT BE COUNTED IN DECLARING A QUORUM FOR THE DETERMINATION OF THE MATTER. THIS PROVISION SHALL NOT BE CONSTRUED AS PREVENTING THE DIRECTOR FROM BRIEFLY STATING A POSITION ON THE MATTER NOR FROM ANSWERING PERTINENT QUESTIONS.FORM 990, PART VI, SECTION B, LINE 12C
FOR THE CEO, THE BOARD CHAIRMAN CONVERSES WITH AN HR CONSULTANT ON MARKET WAGES AND EVALUATION PROCESS. EVALUATION FORMS ARE TYPICALLY COMPLETED BY BOARD MEMBERS AND THE BOARD CHAIRMAN CONDUCTS THE ACTUAL EVALUATION. COMPARABILITY DATA WAS USED BY THOSE WITHOUT CONFLICT AND THE DECISIONS WERE DOCUMENTED.FORM 990, PART VI, SECTION B, LINE 15
THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. PRIOR YEAR 990S CAN BE OBTAINED BY REQUEST OR THROUGH GUIDESTAR.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 283,529.FORM 990, PART XI, LINE 5:
THE CHIEF FINANCIAL OFFICER ASSUMES OVERSIGHT OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS. THE BOARD OF DIRECTORS WITH THE CHIEF FINANCIAL OFFICER ASSUME RESPONSIBLILITY FOR SELECTION OF AN INDEPENDENT ACCOUNTANT.FORM 990, PART XII, LINE 2C

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1JAMESTOWN HOSPITAL FOUNDATION INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1419 5TH ST NEAddressLine1
CityJAMESTOWNCity
StateNDState
ZIP Code58401ZIPCode
FieldValueIRS element (for citing)
EIN363348763EIN
Primary ActivitiesFUNDRAISINGPrimaryActivities
Legal Domicile StateNDLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity StatusLINE 11A, IPublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1LUTHERAN CHARITY ASSOCIATIONBusinessNameLine1
FieldValueIRS element (for citing)
Controlled Org1ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
JAMESTOWN HOSPITAL FOUNDATION INC
C650000COST
JAMESTOWN HOSPITAL FOUNDATION INC
E46000000COST
JAMESTOWN HOSPITAL FOUNDATION INC
O162202COST