2024-05-03T14:32:31-05:00 2023-06-30 450250958 Eide Bailly LLP 1730 Burnt Boat Loop Ste 100 Bismarck ND 585030886 990 2022-07-01 450231181 Lutheran Charity Association D/B/A Jamestown Regional Medical Center LUTH 7019521050 2422 20th Street SW Jamestown ND 584013360 Beverly Fiferlick CFO 7019521050 2024-04-18 1 Beverly Fiferlick 999009999 1 Lisa Chaffee CPA P00193453 7012551091 2024-04-17 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Jamestown Regional Medical Center Mike Delfs 2422 20th Street SW Jamestown ND 584013360 77184266 0 X www.jrmcnd.com X 1927 ND Jamestown Regional Medical Center will be the best rural hospital in the country for patients to receive care, employees to work, and physicians to practice. 10 10 429 101 101395 0 1874335 841075 64935964 75678128 1837420 -171030 15281 7750 68663000 76355923 0 9805 0 0 29451348 32038257 0 0 0 35103354 41934796 64554702 73982858 4108298 2373065 88544787 100349147 47027154 55297466 41517633 45051681 Exceed expectations and be the difference in the lives of those we serve. 0 0 66447117 9805 75579467 Jamestown Regional Medical Center is a 25 bed critical access hospital providing short-term acute inpatient, outpatient, swing bed, home health and hospice health care services. The nearest provider of health care services is more than 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. 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 provided, our facility also provides specialty clinic services including OBGYN, ENT, podiatry, orthopedics, urology, oncology services, and wound care. 66447117 1 1 0 1 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 60 0 1 429 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Beverly Fiferlick 7019521050 2422 20th Street SW Jamestown ND 584013360 Wanda Vining-Alber Chairperson until 10/22 1.00 0.00 X X 0 0 0 Mark Anderson - Vice Chair until 10/22/Chair as of 11/22 1.00 0.00 X X 0 0 0 Casey Henderson - SecrTreas until 10/22/Vice Chair as of 11/22 1.00 0.00 X X 0 0 0 Steve Ottmar - Board Member until 10/22/Secr/Treas as of 11/22 1.00 0.00 X X 0 0 0 Teree Rittenbach Board Member 1.00 0.00 X 0 0 0 Terry Wanzek Board Member 1.00 0.00 X 0 0 0 Tim Burchill Board Member 1.00 1.00 X 0 0 0 Randy Jaspers Board Member 1.00 0.00 X 0 0 0 Briana Bohn Board Member as of 11/22 1.00 0.00 X 0 0 0 Jeremy Rham Board Member as of 11/22 1.00 0.00 X 0 0 0 Amanda Thrift Board Member as of 11/22 1.00 0.00 X 0 0 0 Mike Delfs CEO 40.00 1.00 X 361737 0 62010 Beverly Fiferlick CFO 40.00 1.00 X 221477 0 20335 Dr Michael Dean Orthopedic Surgeon 40.00 0.00 X 725233 0 42824 Dr Scott Geocke ER Physician 48.00 0.00 X 424590 0 24260 Dr Timothy Volk Orthopedic Surgeon 40.00 0.00 X 680239 0 30670 Dr Christopher Cost Urologist 40.00 0.00 X 673288 0 56085 Dr Brent Williams Urologist 40.00 0.00 X 414366 0 21417 3500930 0 257601 53 0 1 0 FocusOne 13609 California St Omaha NE 68154 Contracted workers 3809336 Jamestown Radiology LLC 1400 10th Ave NE 220 Jamestown ND 58401 Radiologist 885810 Charles Allen 1708 Canyon Dr Bismarck ND 58503 ER Physician 138154 Eide Bailly PO Box 2545 Fargo ND 58108 Accounting/auditing services 123485 4 437100 151494 252481 841075 Net Patient Service Revenue 621400 75098430 75098430 Cafeteria 900099 311265 311265 Laundry Services 812300 101395 101395 Auxiliary 900099 9165 9165 157873 157873 75678128 624785 624785 5016 0 5016 5016 5016 696 796511 0 -796511 696 -795815 -795815 34566 31832 2734 2734 76355923 75579467 101395 -166014 X 9805 9805 658246 658246 25164272 23582850 1581422 1681838 1571725 110113 3004744 2823316 181428 1529157 1416378 112779 14579 14579 87998 87998 12908856 10957586 1951270 259137 22607 236530 642802 352332 290470 1335669 1314250 21419 115881 75195 40686 106087 96000 10087 1576974 1095351 481623 3814880 2649780 1165100 334667 51412 283255 Medical Supplies 18312511 18305327 7184 Equipment Lease and Ren 1647917 1645671 2246 Food 384902 384212 690 391936 93320 298616 73982858 66447117 7535741 0 17448024 20845897 8433092 10764426 90804 39563 1026560 1180449 443528 524010 77086637 45701964 33496373 31384673 26825012 27587523 781394 8022606 88544787 100349147 5887292 5852675 803922 619904 37537649 36637694 269466 138974 2528825 12048219 47027154 55297466 X 40951785 44391257 565848 660424 41517633 45051681 88544787 100349147 X 2373065 1067040 93943 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 6737 0 0 0 6737 0 Part II-B, Line 1: The organization pays dues to various professional organizations. A portion of those dues are used towards lobbying expenses. These lobbying expenses go towards advocating for the organization's purpose and mission. 1 4758 9165 8532 5391 0 433429 433429 46835116 25641849 21193267 2996759 1161497 1835262 25426034 18260615 7165419 1395299 638003 757296 31384673 Related Party Receivables 74743 Interest in Foundation 660424 ROU Assets - Operating 7287439 8022606 Estimated Third Party 4760780 Leasing Liabilities - Operating 7287439 12048219 X 77445630 1067040 1067040 76378590 -22667 -22667 76355923 74006158 31832 31832 73974326 8532 8532 73982858 Part IV, Line 1b: There is an auxiliary which operates under the EIN of the Organization. Part X, Line 2: The Organization believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 4b - Other Adjustments: Cost of Goods Sold Included in Expenses on Financial Statements -31,832. Auxiliary Revenues not included in Revenue on Financial Statements 9,165. Part XII, Line 2d - Other Adjustments: Cost of Goods Sold Included in Expenses on Financial Statements 31,832. Part XII, Line 4b - Other Adjustments: Auxiliary Expenses not included in Expenses on Financial Statements 8,532. 1 1 X 1 X 1 X 1 1 0 0 487000 487000 0.00660 487000 487000 0.00660 798 798 0.00000 15834 15834 0.00020 8691993 6772704 1919289 0.02590 8708625 6772704 1935921 0.02610 9195625 6772704 2422921 0.03270 1 757382 654010 24885251 24986601 -101350 X 1 1 1 1 Jamestown Regional Medical Center 2422 20th St SW Jamestown ND 58401 www.jrmcnd.com 5027 X X X X Lutheran Charity Association 1 0 0 1 X X X X X X X X X 20 1 0 1 1 X https://jrmcnd.com/about-us/community-impact/ X 1 20 1 https://jrmcnd.com/about-us/community-impact/ 0 1 X 100.000000000000 300.000000000000 X X X 1 1 X X X X 1 X https://jrmcnd.com/resources/patient-accounts/#policies X https://jrmcnd.com/resources/patient-accounts/#Application X https://jrmcnd.com/resources/patient-accounts/#policies X X X X 1 X 0 X X X X 1 X 0 0 Lutheran Charity Association Part V, Section B, Line 5: In-person meetings, telephone conference, email, paper survey, electronic survey, interviews, steering committee meetings. Lutheran Charity Association Part V, Section B, Line 6b: The CHNA was conducted with Central Valley Health District. Lutheran Charity Association Part V, Section B, Line 11: The following needs were identified in the most recent CHNA:1. Attracting & Retaining Young Families2. Depression & Anxiety in Youth3. Availability of Mental Health Services4. Not Enough Jobs with Livable WagesAttracting & Retaining Young Families/Not Enough Jobs with Livable Wages:In order to address these two needs, the organization worked closely with Jamestown/Stutsman County Development (JSDC) to ensure this need is being met. Mike Delfs, CEO of JRMC, is also a Director at JSDC. JSDC offers an internship reimbursement program. The internship reimbursement program at JSDC provides funding to provide opportunities for advancement of work competencies and wages. Businesses can apply annually with JSDC for funding. 4 Applications were approved for 2023.Depression & Anxiety in Youth:JRMC partnered with the Jamestown United way to address Depression and Anxiety in Youth. Jamestown United Way included this as a priority for 2023 and addressed this need in the following ways:-Safe Halloween event in the park-Improve access to Boy Scouts and Girl Scouts for all families-After school educational programs at the Arts Center designed to keep children engaged and off electronics -Free transportation is provided from public schools to the Arts CenterAvailability of Mental Health Services:-Available community resources were gathered together and summarized in a web accessible guide located at:https://centralvalleyhealth.org/wp-content/uploads/2021/03/Health-and-Wellness-Guide-FINAL.pdf-The guide provides information regarding available resources to address mental health and other wellness resources including the organization's name, contact information, and a brief description of the services provided in one convenient location. Lutheran Charity Association Part V, Section B, Line 13h: The patient may be asked to provide additional information to help determine eligibility for financial assistance that is not based upon the federal poverty guidelines. Items the patient is asked to also provide include:-Medical Assistance eligibility/denial notice if applicable-Income tax returns for the 2 most recently filed years-Proof of income and adjusted gross income such as pay stubs from the past 6 pay periods, W-2 withholding statements, Social Security checks, receipts, or deposits, and bank statements-Notification of Benefit decision from the ND Department of Human Services Part V, Section B, Line 7a: CHNA:https://jrmcnd.com/about-us/community-impact/ 1 1 - JRMC Clinic 2422 20th Street SW Jamestown ND 58401 Specialty Clinic Part I, Line 3c: The patient may be asked to provide additional information to help determine eligibility for financial assistance that is not based upon the federal poverty guidelines. Items the patient is asked to also provide include:-Medical Assistance eligibility/denial notice if applicable-Income tax returns for the 2 most recently filed years-Proof of income and adjusted gross income such as pay stubs from the past 6 pay periods, W-2 withholding statements, Social Security checks, receipts, or deposits, and bank statements-Notification of Benefit decision from the ND Department of Human Services Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Community Health Improvement Services, line 7e, and Health Professions education, line 7f, are reported based on actual expense amounts recorded in the general ledger. The cost for subsidized health services, line 7g, was determined using the Medicare Cost Report. Part III, Line 2: The amount reported on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concessions based on its historical collection experience with this class of patients. Part III, Line 3: JRMC pulled the Implicit Price Concessions balance as of the end of FY22. We ran all the prior period charity transactions that were adjusted off in FY23 and pulled out the charity transaction amounts that had been previously sent to collections. We calculated the percentage of Charity that had previously been reported as Implicit Price Concessions and applied that percentage to the FY23 Implicit Price Concessions Amount. Part III, Line 4: The footnote to the Organization's financial statements addressing implicit price concessions can be found on page 13 and 14 of the attached audited financial statements. Part III, Line 8: IRS Rev. Rul. 69-545, which established the community benefit standard for nonprofit hospitals, states that if a hospital serves patients with government health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community. In some communities, Medicare is the largest payer, and hospitals must accept these patients regardless of whether they make a surplus or deficit from providing such services. If the Medicare participation is premised on this fact, then providing Medicare services promotes access to healthcare services which is a community benefit. Also, the elderly are often an underserved population who experience issues with access to healthcare services. Without tax-exempt hospitals providing Medicare services, the government would bear the burden of directly providing services to the elderly. Medicare allowable costs are based on the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Part III, Line 9b: All Extraordinary Collection Actions will be precaution on the patients or guarantor's fourth statement clearly indicating the 30 day notice of these actions to begin. In the event a patient or guarantor has reached the 120 day window with a non-completed financial assistance application, Jamestown Regional Medical Center will notify the patient in writing of the incomplete application with Extraordinary Collection Actions preceding in 30 days from notification if application is not completed.Extraordinary Collection Actions will not be taken by JRMC against an individual related to obtaining payment of a bill for care covered under the hospital's Community Care Program that require a legal or judicial process or involve selling an individual's debt to another party or reporting adverse information about the individual to consumer credit reporting agencies or credit bureaus. Part VI, Line 2: The Community Health Partnership was formed in March 2013 after the completion of the 2012 Community Health Assessment and Community Health Improvement Plan. The Community Health Partnership is comprised of community members and numerous community agencies. The purpose of the Community Health Partnership is to provide effective, quality health and safety services in an environment that enables community members to reach their full potential through assessment, leadership and partnerships. The goals of the community health partnership are:-Enhance efficiency of community connections-Decrease duplication of efforts (and meetings)-Improve awareness and health within the community (Stutsman County)-Be an asset to the community by improving community healthThe organization also completed its latest Community Health Needs Assessment during the 6/30/21 fiscal year. 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 care link which explains the program and allows forms to be downloaded and printed. Part VI, Line 4: Jamestown Regional Medical Center serves a nine county area of South Central North Dakota. The primary industry is agriculture. The population is 52,155 with 21% over the age of 65. The average age is 42. Male and female population is split evenly. Average income by household is $53,650. There are two colleges within Jamestown Regional Medical Center trade area. Jamestown Regional Medical Center is the only birthing center within a 90 mile radius. Part VI, Line 5: A majority of the Governing body is comprised of persons who reside in the organization's primary service area who are neither employees nor contractors of Jamestown Regional Medical Center, nor family members thereof. Jamestown Regional Medical Center extends medical staff privileges to all qualified physicians in the community. Jamestown Regional Medical Center recently moved into a new replacement hospital which has many upgrades in technology, most of which are related to improving patient care. Surplus funds, when available, are used to invest in both capital assets and medical equipment in order to improve patient care. Jamestown Regional Medical Center operates an emergency room available to everyone, regardless of ability to pay. They offer a specialty clinic which provides services that the community would otherwise have to travel to receive. The hospital also offers many opportunities for community members to volunteer within the organization. X X X 0 0 0 0 0 0 0 1 0 Dr Michael Dean Orthopedic Surgeon 694373 0 30860 0 0 0 33814 0 9179 0 768226 0 0 0 Dr Christopher Cost Urologist 672428 0 860 0 0 0 35750 0 20504 0 729542 0 0 0 Dr Timothy Volk Orthopedic Surgeon 651379 0 28860 0 0 0 16250 0 14588 0 711077 0 0 0 Dr Scott Geocke ER Physician 423730 0 860 0 0 0 15250 0 9179 0 449019 0 0 0 Dr Brent Williams Urologist 414366 0 0 0 0 0 9066 0 12451 0 435883 0 0 0 Mike Delfs CEO 320689 0 41048 0 0 0 42250 0 19929 0 423916 0 0 0 Beverly Fiferlick CFO 220108 0 1369 0 0 0 0 0 20504 0 241981 0 0 0 Part I, Line 7 There is an incentive plan specifically for the CEO. This plan is designed to encourage, recognize and reward superior job and organizational performance. Incentive awards that may be paid under the terms of this plan are determined by overall organizational and individual performance for the annual operating period. The Chair of the Board of Directors has the responsibility to implement this plan. The incentives for the CEO are expressed as a percentage of the participant's base salary at the end of the incentive plan year. The maximum award is approved by the Board for each plan year. There is a detailed criterion for the results of what the organization considers a superior job. The criteria uses goal driven measures that intend to incentivize important long term strategic objectives over short term efforts only. The CEO's performance is measured based on the following areas of focus: Service, Quality, Financial, People, Growth, and Personal Growth. There is a ranking system for sets of criterion, and the Board of Directors is to utilize this system in determining the level of incentive the CEO will receive. Form 990, Part VI, Section A, line 1a The Governance Committee consists of the officers of the Board of Directors. A majority of the members of the Governance Committee constitutes a quorum. The Governance Committee: A. Reviews the performance of the President/Chief Executive Officer of the Jamestown Regional Medical Center on the anniversary date of employment and report the findings to the Board of Directors. B. Assists our board to fulfill its responsibilities for ensuring high levels of governance performance and contribution. C. Assists our board to appoint and re-appoint directors; and formulating policies regarding making decisions about and overseeing governance effectiveness, efficiency, creativity and adaptability. D. Takes action on behalf of our board in emergency situations when we cannot be convened; emergency actions taken by the Governance Committee must be reported to the, and discussed/ratified by, our board at its next regularly scheduled meeting. Form 990, Part VI, Section B, line 11b The preparer of the Form 990 provides an electronic copy of the final 990 to the organization's Chief Financial Officer. The Chief Financial Officer performs a detailed review of Form 990. The Chief Financial Officer provides each voting Board Member with a copy of the Form 990 prior to submitting to the Internal Revenue Service. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers employees and board members. The Compliance Officer reviews all potential conflicts and determines if a conflict exists. Directors are asked at every board meeting whether or not anyone has a duality of interest or conflict of interest. Directors having a duality of interest or a possible conflict of interest on any matter which comes before the board shall not vote on the matter or use their personal influence on the matter. The minutes of the meeting shall reflect that a disclosure of duality or conflict of interest was made, and the director making such a disclosure shall not be counted in declaring a quorum for the determination of the matter. This provision shall not be construed as preventing the director from briefly stating a position on the matter nor from answering pertinent questions. Form 990, Part VI, Section B, line 15 For the CEO, the Board Chairman converses with an HR consultant on market wages and evaluation process. Evaluation forms are typically completed by board members and the Board Chairman conducts the actual evaluation. Comparability data was used by those without conflict and the decisions were documented. This process takes place annually. The CFO is evaluated and compensated based on the Employee Performance Assessment policy that is standard for the organization. Comparability data is also used to determine adjustments to compensation. Form 990, Part VI, Section C, line 19 The organization does not make its governing documents, conflict of interest policy and financial statements available to the public. Form 990, Part IX, line 11g Consulting Services: Program service expenses 712,830. Management and general expenses 408,693. Fundraising expenses 0. Total expenses 1,121,523. Maintenance and Repair: Program service expenses 1,217,476. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,217,476. Other Purchased Services: Program service expenses 9,027,280. Management and general expenses 546,406. Fundraising expenses 0. Total expenses 9,573,686. Contracts: Program service expenses 0. Management and general expenses 996,171. Fundraising expenses 0. Total expenses 996,171. Form 990, Part XI, line 9: Change in Interest in Foundation 94,576. Change in Auxiliary Net Assets -633. Jamestown Regional Medical Center Foundation Inc 2422 20th St SW Jamestown ND 58401 363348763 Fundraising ND 501(c)(3) Line 12a, I Lutheran Charity Association 1 Nierling Jamestown Hospital Trust 2422 20th Street SW Jamestown ND 58401 912004888 Charitable Trust ND Lutheran Charity Association (DBA Jamestown Regional Medical Center) T 13008 107018 1.00000 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 0 0 Jamestown Regional Medical Center Foundation Inc C 437100 cost Jamestown Regional Medical Center Foundation Inc Q 367659 cost