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Nonprofiteer
← HAZEN MEMORIAL HOSPITAL ASSOCIATION

Form 990 for tax year 2022

Filed by HAZEN MEMORIAL HOSPITAL ASSOCIATION.

Totals

Total revenue
$17,323,183
Total expenses
$16,321,958
Contributions and grants received
$713,996
Grants paid
$1,042
Program service revenue
$15,928,716
Investment income
$475,222
Other revenue
$205,249
Total assets, end of year
$41,523,644
Total liabilities, end of year
$24,464,916
Net assets or fund balances, end of year
$17,058,728
Program services expenses (Part IX)
$13,731,522
Management and general expenses
$2,590,436
Fundraising expenses
$0
Program service expenses (Part III)
$13,731,522

Program services were 84.1% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1e · Government grants (contributions)

    $185,254

  • 1f · All other contributions, gifts and grants

    $528,742

  • 2a · Program service revenue: Patient and Resident Services

    total $15,534,249 · related or exempt $15,534,249

  • 2b · Program service revenue: Other Program Revenue

    total $273,875 · related or exempt $273,875

  • 2c · Program service revenue: Cafeteria

    total $78,885 · related or exempt $78,885

  • 2d · Program service revenue: Education

    total $41,707 · related or exempt $41,707

  • 3 · Investment income

    total $475,222 · excluded $475,222

  • 6a · Gross rents

    real property $196,865

  • 6b · Less rental expenses

    real property $0

  • 6c · Rental income or loss

    real property $196,865

  • 6d · Net rental income or loss

    total $196,865 · excluded $196,865

  • 8a · Fundraising events: gross income

    $11,201

  • 8b · Fundraising events: direct expenses

    $2,817

  • 8c · Net income from fundraising events

    total $8,384 · excluded $8,384

Functional expenses

Part IX, the statement of functional expenses.

  • 2 · Grants to domestic individuals

    total $1,042 · program services $1,042

  • 5 · Compensation of officers, directors and key employees

    total $336,665 · management and general $336,665

  • 6 · Compensation of disqualified persons

    total $25,795 · management and general $25,795

  • 7 · Other salaries and wages

    total $6,748,403 · program services $6,192,644 · management and general $555,759

  • 8 · Pension plan contributions

    total $236,020 · program services $216,749 · management and general $19,271

  • 9 · Other employee benefits

    total $700,793 · program services $480,135 · management and general $220,658

  • 10 · Payroll taxes

    total $493,556 · program services $444,772 · management and general $48,784

  • 11b · Fees: legal

    total $1,115 · management and general $1,115

  • 11c · Fees: accounting

    total $105,260 · management and general $105,260

  • 11g · Fees: other

    total $2,224,099 · program services $2,116,919 · management and general $107,180

  • 12 · Advertising and promotion

    total $51,345 · management and general $51,345

  • 13 · Office expenses

    total $199,311 · program services $105,318 · management and general $93,993

  • 14 · Information technology

    total $116,473 · management and general $116,473

  • 16 · Occupancy

    total $675,398 · program services $652,316 · management and general $23,082

  • 17 · Travel

    total $40,508 · program services $27,614 · management and general $12,894

  • 20 · Interest

    total $402,495 · program services $297,647 · management and general $104,848

  • 22 · Depreciation, depletion and amortization

    total $1,898,857 · program services $1,417,281 · management and general $481,576

  • 23 · Insurance

    total $12,283 · program services $12,283

  • 24a · Other expenses: Medical Supplies

    total $1,528,237 · program services $1,528,237

  • 24b · Other expenses: Food

    total $158,057 · program services $158,057

  • 24c · Other expenses: Dues & Subscriptions

    total $78,897 · program services $48,515 · management and general $30,382

  • 24e · All other expenses

    total $287,349 · program services $31,993 · management and general $255,356

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $19,154 · end of year $19,615

  • 2 · Savings and temporary cash investments

    beginning of year $15,013,127 · end of year $16,552,705

  • 4 · Accounts receivable

    beginning of year $1,372,744 · end of year $1,748,757

  • 8 · Inventories for sale or use

    beginning of year $394,630 · end of year $401,263

  • 9 · Prepaid expenses and deferred charges

    beginning of year $134,708 · end of year $115,351

  • 10a · Land, buildings and equipment: cost or other basis

    $36,946,781

  • 10b · Land, buildings and equipment: accumulated depreciation

    $17,013,836

  • 10c · Land, buildings and equipment, net

    beginning of year $21,405,778 · end of year $19,932,945

  • 11 · Investments: publicly traded securities

    beginning of year $1,267,084 · end of year $1,296,486

  • 13 · Investments: program-related

    beginning of year $1,156,539 · end of year $1,018,994

  • 15 · Other assets

    beginning of year $476,509 · end of year $437,528

  • 17 · Accounts payable and accrued expenses

    beginning of year $1,024,119 · end of year $1,066,102

  • 22 · Loans and payables to officers and key people

    beginning of year $8,721,528 · end of year $8,455,520

  • 23 · Secured mortgages and notes payable

    beginning of year $15,301,367 · end of year $14,659,039

  • 25 · Other liabilities

    beginning of year $0 · end of year $284,255

  • 27 · Net assets without donor restrictions

    beginning of year $14,965,874 · end of year $15,968,392

  • 28 · Net assets with donor restrictions

    beginning of year $1,227,385 · end of year $1,090,336

Mission and programs · 2022

Mission

Working together as partners to enhance the lives of area residents by providing a neighborhood of patient centered healthcare services that promote wellness, prevention, and care coordination.

Activities or mission (Part I)

To be the preeminent providers of innovative and collaborative healthcare services.

  • Sakakawea Medical Center (SMC) is a 13-bed critical access hospital providing services in the following areas - acute care, observation, surgery, intermediate and skilled swing bed, emergency room with trauma level V certification, Saturday urgent care, and hospice. Services provided by the ancillary departments include physical therapy, occupational therapy, radiology, 3D mammography, bone density, ultrasound, CT, nuclear med, MRI, laboratory, respiratory therapy, cardiac rehab, EKG, Holter Monitor, and thallium stress tests. Based on charges foregone Sakakawea Medical Center provided $140,198 in charity care. Also available to all self-pay patients, regardless of financial status, is a 30% discount policy for timely payments. SMC is a participating provider for Medicare, Medicaid, Blue Cross Blue Shield and other insurances.Sakakawea Medical Center reaches out to the communities in the service area through programs such as falls prevention classes, CPR education, ACLS classes, PALS classes, grief support groups, smoking cessation classes, occupational health, free blood pressure checks, a Christmas giving tree project, a Community Care nurse and health career presentations to high schools. SMC sponsors several community events that promote good health and wellness education including Women's World of Wellness and Mammography Marathon. Wellness screenings are provided to area schools and businesses. SMC provides community education programs on requested topics free of charge. It is important for Sakakawea Medical Center to serve our communities by providing all of their health care needs.

    Expenses $12,707,325 · Grants $1,042 · Revenue $15,128,512

  • Senior Suites is a basic care facility that was completed in April 1997. It is adjacent to Sakakawea Medical Center. Senior Suites can accommodate 34 residents with single or double rooms. It features a licensed beauty shop, activity room, spacious commons areas and an enclosed nurse's station. The rooms are set up like suites, hence the name "Senior Suites." The facility is available to those in the senior population that require a minimal amount of supervision, but do not require 24 hour services. The residents are provided with assistance for daily living and medication administration. Resident care census days totaled 4,507 this year.

    Expenses $1,024,197 · Revenue $800,204

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Fred Stern

    President

    Total calculated
    $0
    Hours/week
    2

  • Christie Obenauer-Huber

    Vice President

    Total calculated
    $0
    Hours/week
    1.5

  • Myria Perry

    Secretary/Treasurer

    Total calculated
    $0
    Hours/week
    1.5

  • Don Lyn Erickson

    Director

    Total calculated
    $0
    Hours/week
    1.5

  • Robin Richter

    Director

    Total calculated
    $0
    Hours/week
    1.5

  • Todd Lindquist

    Director

    Total calculated
    $0
    Hours/week
    1.5

  • Beverly Huber

    Director

    Total calculated
    $0
    Hours/week
    1.5

  • Wayne Hoffner

    Director

    Total calculated
    $0
    Hours/week
    1.5

  • Rachel Connolly

    Director

    Total calculated
    $0
    Hours/week
    1.5

  • Daren Eliason

    Director

    Total calculated
    $0
    Hours/week
    1.5

  • Martha Raad

    Director

    Total calculated
    $0
    Hours/week
    1.5

  • Jesse Krieger

    Director

    Total calculated
    $0
    Hours/week
    1.5

  • Brian Williams

    CEO (July-March)

    Total calculated
    $157,027
    From this org
    $157,027
    From related orgs
    $0
    Other
    $0
    Hours/week
    19.6

    Schedule J breakdown matched by us

    Base
    $157,027
    Bonus
    $0
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $157,027

  • Melissa Dillman

    CFO

    Total calculated
    $106,811
    From this org
    $101,703
    From related orgs
    $0
    Other
    $5,108
    Hours/week
    36

  • Darrold Bertsch

    CEO (March-June)

    Total calculated
    $40,000
    From this org
    $40,000
    From related orgs
    $0
    Other
    $0
    Hours/week
    19.6

    Schedule J breakdown matched by us

    Base
    $0
    Bonus
    $0
    Other
    $40,000
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $40,000

  • Michael Schmit

    Surgeon

    Total calculated
    $365,035
    From this org
    $335,844
    From related orgs
    $0
    Other
    $29,191
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $335,844
    Bonus
    $0
    Other
    $0
    Deferred
    $12,200
    Nontaxable benefits
    $17,046
    Filer's total
    $365,090

  • Carl Miller

    CRNA

    Total calculated
    $213,694
    From this org
    $180,879
    From related orgs
    $0
    Other
    $32,815
    Hours/week
    36

    Schedule J breakdown matched by us

    Base
    $180,879
    Bonus
    $0
    Other
    $0
    Deferred
    $7,246
    Nontaxable benefits
    $25,624
    Filer's total
    $213,749

  • Kimberley Myklebust

    FNP-C

    Total calculated
    $176,437
    From this org
    $152,816
    From related orgs
    $0
    Other
    $23,621
    Hours/week
    36

    Schedule J breakdown matched by us

    Base
    $152,816
    Bonus
    $0
    Other
    $0
    Deferred
    $6,138
    Nontaxable benefits
    $17,538
    Filer's total
    $176,492

  • Alyssa Wolden

    Pharmacist

    Total calculated
    $143,034
    From this org
    $128,369
    From related orgs
    $0
    Other
    $14,665
    Hours/week
    36

  • Steven Ziegler

    Director of Rehabiliation

    Total calculated
    $145,122
    From this org
    $114,437
    From related orgs
    $0
    Other
    $30,685
    Hours/week
    40

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 3 · Compensation committee
  • 3 · Form 990 of other organizations
  • 3 · Written employment contract
  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee
  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

Part I, Line 4b
SMC paid $40,000 for a 457(f) plan for Darrold Bertsch, CEO. The amount reported on Form 990, Part VII is the calander year 2022 payout of his 457(f) plan that was previously reported as deferred compensation on prior year Form 990s.
Schedule J, Part II:
Brian Williams, CEO, was an employee of Coal Country Community Health Center (CCCHC) and provided CEO services to both SMC and CCCHC. However, as an employee of CCCHC, Brian received his W-2 from CCCHC. Sakakawea Medical Center reimbursed CCCHC for part of Brian's salary based on a contract. The compensation reported in Part VII of the core form and Schedule J, Part II reflected total base compensation, benefits and payroll taxes associated with this compensation on which SMC reimbursed CCCHC for his services solely to SMC, which was reported on his 2022 Form W-2 from CCCHC.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Provenance

Return type
form_990
Tax year
2022
Filed
1 March 2024
IRS schema version
2022v5.0
Source object
202440619349300954

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