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Nonprofiteer
← GOOD SAMARITAN HOSPITAL ASSOCIATION

Form 990 for tax year 2022

Filed by GOOD SAMARITAN HOSPITAL ASSOCIATION.

Totals

Total revenue
$37,554,250
Total expenses
$28,691,018
Contributions and grants received
$3,678,984
Grants paid
$50,000
Program service revenue
$28,239,433
Investment income
$184,937
Other revenue
$5,450,896
Total assets, end of year
$34,054,250
Total liabilities, end of year
$5,159,564
Net assets or fund balances, end of year
$28,894,686
Program services expenses (Part IX)
$24,395,299
Management and general expenses
$4,215,253
Fundraising expenses
$80,466
Program service expenses (Part III)
$24,395,299

Program services were 85.0% 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.

  • 1d · Related organizations

    $1,453,251

  • 1e · Government grants (contributions)

    $2,000,121

  • 1f · All other contributions, gifts and grants

    $225,612

  • 2a · Program service revenue: Patient Service Revenue

    total $25,131,611 · related or exempt $25,131,611

  • 2b · Program service revenue: Pharmacy Revenue

    total $2,040,154 · related or exempt $2,040,154

  • 2c · Program service revenue: Daycare Services

    total $174,998 · related or exempt $174,998

  • 2d · Program service revenue: Cafeteria Revenue

    total $82,051 · related or exempt $82,051

  • 2f · All other program service revenue

    total $810,619 · related or exempt $810,619

  • 3 · Investment income

    total $184,937 · excluded $184,937

  • 6a · Gross rents

    real property $55,500

  • 6b · Less rental expenses

    real property $0

  • 6c · Rental income or loss

    real property $55,500

  • 6d · Net rental income or loss

    total $55,500 · excluded $55,500

  • 11a · Other revenue: Employee Retention Credit

    total $5,395,396 · excluded $5,395,396

  • 11e · Other revenue, total

    $5,395,396

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $50,000 · program services $50,000

  • 5 · Compensation of officers, directors and key employees

    total $551,698 · program services $179,223 · management and general $372,475

  • 6 · Compensation of disqualified persons

    total $278,203 · program services $278,203

  • 7 · Other salaries and wages

    total $14,112,450 · program services $12,496,820 · management and general $1,615,630

  • 8 · Pension plan contributions

    total $265,212 · program services $236,368 · management and general $28,844

  • 9 · Other employee benefits

    total $1,534,360 · program services $1,368,478 · management and general $165,882

  • 10 · Payroll taxes

    total $1,040,825 · program services $905,208 · management and general $135,617

  • 11b · Fees: legal

    total $68,892 · management and general $68,892

  • 11c · Fees: accounting

    total $530,904 · management and general $530,904

  • 11e · Fees: professional fundraising services

    total $80,466 · fundraising $80,466

  • 11g · Fees: other

    total $2,025,150 · program services $1,595,000 · management and general $430,150

  • 12 · Advertising and promotion

    total $33,576 · management and general $33,576

  • 13 · Office expenses

    total $371,298 · program services $231,877 · management and general $139,421

  • 14 · Information technology

    total $32,989 · management and general $32,989

  • 16 · Occupancy

    total $1,077,059 · program services $967,718 · management and general $109,341

  • 17 · Travel

    total $84,445 · program services $63,650 · management and general $20,795

  • 19 · Conferences, conventions and meetings

    total $88,477 · program services $41,523 · management and general $46,954

  • 20 · Interest

    total $56,650 · program services $56,650

  • 22 · Depreciation, depletion and amortization

    total $1,387,550 · program services $1,222,871 · management and general $164,679

  • 23 · Insurance

    total $236,606 · management and general $236,606

  • 24a · Other expenses: Medical Supplies

    total $3,299,314 · program services $3,299,314

  • 24b · Other expenses: Repairs & Maintenance

    total $761,919 · program services $761,919

  • 24c · Other expenses: Food

    total $409,938 · program services $409,938

  • 24d · Other expenses: Dues and Subscriptions

    total $48,602 · program services $3,660 · management and general $44,942

  • 24e · All other expenses

    total $264,435 · program services $226,879 · management and general $37,556

Balance sheet

Part X, book values.

  • 2 · Savings and temporary cash investments

    beginning of year $7,614,046 · end of year $7,624,770

  • 4 · Accounts receivable

    beginning of year $3,325,728 · end of year $2,665,542

  • 8 · Inventories for sale or use

    beginning of year $249,502 · end of year $233,578

  • 9 · Prepaid expenses and deferred charges

    beginning of year $238,223 · end of year $319,007

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

    $22,717,731

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

    $12,021,010

  • 10c · Land, buildings and equipment, net

    beginning of year $7,856,020 · end of year $10,696,721

  • 11 · Investments: publicly traded securities

    beginning of year $138,603 · end of year $139,693

  • 13 · Investments: program-related

    beginning of year $105,277 · end of year $114,222

  • 15 · Other assets

    beginning of year $2,456,582 · end of year $12,260,717

  • 17 · Accounts payable and accrued expenses

    beginning of year $2,608,100 · end of year $3,698,588

  • 19 · Deferred revenue

    beginning of year $755,090 · end of year $0

  • 20 · Tax-exempt bond liabilities

    beginning of year $217,795 · end of year $0

  • 21 · Escrow or custodial account liability

    beginning of year $18,361 · end of year $16,892

  • 23 · Secured mortgages and notes payable

    beginning of year $1,148,979 · end of year $0

  • 25 · Other liabilities

    beginning of year $474,454 · end of year $1,444,084

  • 27 · Net assets without donor restrictions

    beginning of year $15,905,005 · end of year $23,669,988

  • 28 · Net assets with donor restrictions

    beginning of year $856,197 · end of year $5,224,698

Mission and programs · 2022

Mission

To deliver compassionate care by advancing the physical and spiritual well-being of the communities we serve through smart medicine and exceptional service.

Activities or mission (Part I)

Provide quality medical care based on the needs and demographics of north central North Dakota.

  • Good Samaritan Hospital Association (GSHA) is a nonprofit health care organization, owned by 20 area churches representing all the local denominations of the Christian faith. The area churches at an annual meeting every year elect a board of trustees. This board is the legal governing body that is responsible for the Association. GSHA's primary focus is healthcare within and around the community of Rugby, ND. GSHA is a 25 bed licensed acute/swing bed critical access hospital, 3 rural health clinics (Rugby, Dunseith, Maddock), along with an Operating Room, and provider based surgical clinic & pain clinic, 33 skilled nursing home beds (2 in layaway), 60 basic care beds, and 37 assisted living apartments. We also service the community through a robust hospital-based hospice program. GHSA was impacted by COVID as we continued to see increased charity care due to patients being impacted with COVID. We continued to provide COVID testing to the community, and our infection control nurse was working with public health to improve the community's awareness. The CEO performed numerous health updates on the radio to educate the community about the public health emergency and changes that were coming from CMS. GSHA provides numerous community and social programs including, but not limited to the following: Charity Care - the estimated cost of providing charity care services was $141,000 during the year ended March 31, 2023 (calculated by multiplying the ratio of cost to gross charges for the Organization by the gross uncompensated charges associated with providing charity care to patients), reduced fee flu shot clinics, diabetic education program, chronic care management, public healthcare educational and informational notices, testing and information during health shows and community events, ambulance volunteers at the local events, provided EMT courses for ambulance services, educational outreach for school system, provides senior citizen meals, free blood pressure checks, community education, physical therapy, provided meeting room for various organizations and churches, CPR training, wellness programs. We also worked to build relationships with the affiliated CNA/LPN/RN school programs through a consortium of facilities and colleges. Ambulance Service is operated by the hospital association as the community was unable to sustain as a volunteer service. We staff the ambulance 24/7 and answer all 911 calls in our area as well as perform community service when someone is unable to make it to the hospital. The crew has gone to homes for blood draws. We subsize some of the expenses of operating this ambulance department with a mill levy and a state grant.

    Expenses $24,395,299 · Grants $50,000 · Revenue $28,239,433

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

Listed in Part VII

  • Ronald Skipper MD

    ER Provider

    Total calculated
    $387,773
    From this org
    $353,901
    From related orgs
    $0
    Other
    $33,872
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $350,201
    Bonus
    $3,700
    Other
    $0
    Deferred
    $7,201
    Nontaxable benefits
    $29,446
    Filer's total
    $390,548

  • Cammy Kelsch FNP-C

    ER Provider

    Total calculated
    $340,911
    From this org
    $304,230
    From related orgs
    $0
    Other
    $36,681
    Hours/week
    66.5

    Schedule J breakdown matched by us

    Base
    $300,530
    Bonus
    $3,700
    Other
    $0
    Deferred
    $7,641
    Nontaxable benefits
    $31,726
    Filer's total
    $343,597

  • Steven Schoneberg MD

    Physician

    Total calculated
    $296,134
    From this org
    $266,875
    From related orgs
    $0
    Other
    $29,259
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $258,175
    Bonus
    $8,700
    Other
    $0
    Deferred
    $6,702
    Nontaxable benefits
    $25,111
    Filer's total
    $298,688

  • Chelsey Wyatt

    CRNA

    Total calculated
    $279,179
    From this org
    $250,487
    From related orgs
    $0
    Other
    $28,692
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $246,787
    Bonus
    $3,700
    Other
    $0
    Deferred
    $1,127
    Nontaxable benefits
    $30,340
    Filer's total
    $281,954

  • Josalynne Hoff Rue MD

    Physician

    Total calculated
    $279,475
    From this org
    $244,378
    From related orgs
    $0
    Other
    $35,097
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $234,596
    Bonus
    $8,700
    Other
    $1,082
    Deferred
    $5,911
    Nontaxable benefits
    $31,664
    Filer's total
    $281,953

  • Dustin Hager

    COO & Provider

    Total calculated
    $227,422
    From this org
    $192,752
    From related orgs
    $0
    Other
    $34,670
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $183,944
    Bonus
    $8,808
    Other
    $0
    Deferred
    $4,357
    Nontaxable benefits
    $31,836
    Filer's total
    $228,945

  • Erik Christenson

    Secretary - CEO

    Total calculated
    $148,807
    From this org
    $115,389
    From related orgs
    $0
    Other
    $33,418
    Hours/week
    58 + 2 related

    Schedule J breakdown matched by us

    Base
    $111,689
    Bonus
    $3,700
    Other
    $0
    Deferred
    $3,109
    Nontaxable benefits
    $31,778
    Filer's total
    $150,276

  • Melissa Shepard

    Treasurer - CFO

    Total calculated
    $146,593
    From this org
    $134,475
    From related orgs
    $0
    Other
    $12,118
    Hours/week
    58 + 2 related

  • Will Griffin - President

    (April-July)/Trustee (as of July)

    Total calculated
    $0
    Hours/week
    1

  • Wayne Trottier - Vice Chair

    (April-July)/President (Aug-March)

    Total calculated
    $0
    Hours/week
    1

  • Michael Graner - Trustee

    (until Aug)/Vice Chair (Aug-March)

    Total calculated
    $0
    Hours/week
    1

  • Travis Maddock

    Trustee (as of May)

    Total calculated
    $0
    Hours/week
    1

  • Annette Leier

    Trustee (April-Oct)

    Total calculated
    $0
    Hours/week
    1

  • Craig Zachmeier

    Trustee

    Total calculated
    $0
    Hours/week
    1

  • Lisa Thorp

    Trustee (Nov-March)

    Total calculated
    $0
    Hours/week
    1

  • Kolin Johnson

    Trustee

    Total calculated
    $0
    Hours/week
    1

  • Deanna Marchus

    Trustee (April-Oct)

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • Kim Bott

    Trustee

    Total calculated
    $0
    Hours/week
    1

  • Tanner Johnson

    Trustee

    Total calculated
    $0
    Hours/week
    1

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 · Compensation survey or study
  • 3 · Approval by the board or compensation committee

Answered no

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 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

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

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Provenance

Return type
form_990
Tax year
2022
Filed
21 September 2023
IRS schema version
2022v5.0
Source object
202322659349301417

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