NELSON COUNTY HEALTH SYSTEM-HOSPITAL

Address
200 N MAIN ST
MCVILLE, ND 582540367
Contact
Website: http://www.nelsoncountyhealthsystem.org
Phone: +1 (701) 322-4328
Nonprofit
NTEE: E22 - Hospital, General
EIN: 45-0119890

Mission

THE MISSION OF NELSON COUNTY HEALTH SYSTEM IS TO ENHANCE THE HEALTH STATUS AND QUALITY OF LIFE FOR PEOPLES AND COMMUNITIES SERVED.
 20162015201420132012
Basic features of the organization
Year of formation1917
Form of organization
CorporationTrue
Human resources, including compensation
Summary compensation info
Total compensation of current key personnel$237,918.00 $106,534.00$152,366.00$143,695.00
Sum of reportable (W2/1099) compensation$220,774.00 $306,514.00$346,745.00$497,258.00
Number of employees108 121115109
Number of people compensated >$100k0 112
Number of volunteers22 282025
Number of highly compensated contractors2 1  
Personnel
Berg, Ivan
TitleVICE PRESIDENT VICE PRESIDENTDIRECTORDIRECTOR
Name of key/compensated personIVAN BERG IVAN BERGIVAN BERGIVAN BERG
Position of compensated person
Current individual trustee or directorTrue TrueTrueTrue
Current officerTrue True  
Average hours per week working for org5.00 5.003.003.00
Reportable compensation from org$0.00 $0.00$0.00$0.00
Other comp, non-reportable, from org and related orgs$0.00 $0.00$0.00$0.00
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00 $0.00$0.00$0.00
Bina, Betty
Title   DIRECTORDIRECTOR
Name of key/compensated person   BETTY BINABETTY BINA
Position of compensated person
Current individual trustee or director   TrueTrue
Average hours per week working for org   3.003.00
Reportable compensation from org   $0.00$0.00
Other comp, non-reportable, from org and related orgs   $0.00$0.00
Corresponding comp from related orgs
Reportable compensation from related orgs    $0.00$0.00
Bjorlie, Brenda
Title   DIRECTORDIRECTOR
Name of key/compensated person   BRENDA BJORLIEBRENDA BJORLIE
Position of compensated person
Current individual trustee or director   TrueTrue
Average hours per week working for org   3.003.00
Reportable compensation from org   $0.00$0.00
Other comp, non-reportable, from org and related orgs   $0.00$0.00
Corresponding comp from related orgs
Reportable compensation from related orgs    $0.00$0.00
Bowersox, Bruce
TitleCEO CEO  
Name of key/compensated personBRUCE BOWERSOX BRUCE BOWERSOX  
Position of compensated person
Current officerTrue True  
Average hours per week working for org40.00 40.00  
Reportable compensation from org$64,781.00 $26,531.00  
Other comp, non-reportable, from org and related orgs$6,697.00 $2,381.00  
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00 $0.00  
Cox, Robin
Title    PHYSICIAN
Name of key/compensated person    ROBIN COX
Position of compensated person
Average hours per week working for org    40.00
Reportable compensation from org    $178,632.00
Other comp, non-reportable, from org and related orgs    $16,903.00
Corresponding comp from related orgs
Reportable compensation from related orgs     $0.00
Czarnik, Tamarack
Title  PHYSICIANPHYSICIANPHYSICIAN
Name of key/compensated person  TAMARACK CZARNIKTAMARACK CZARNIKTAMARACK CZARNIK
Position of compensated person
Average hours per week working for org  40.0040.0040.00
Reportable compensation from org  $212,905.00$207,675.00$187,879.00
Other comp, non-reportable, from org and related orgs  $18,649.00$17,614.00$16,903.00
Corresponding comp from related orgs
Reportable compensation from related orgs   $0.00$0.00$0.00
Forde, Steve
TitleCFO CFOCFOCFO
Name of key/compensated personSTEVE FORDE STEVE FORDESTEVE FORDESTEVE FORDE
Position of compensated person
Current officerTrue TrueTrueTrue
Average hours per week working for org40.00 40.0040.0040.00
Reportable compensation from org$74,631.00 $67,078.00$60,353.00$57,302.00
Other comp, non-reportable, from org and related orgs$16,475.00 $7,144.00$6,748.00$6,474.00
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00 $0.00$0.00$0.00
Haabak, Victoria
TitleDIRECTOR DIRECTORDIRECTORDIRECTOR
Name of key/compensated personVICTORIA HAABAK VICTORIA HAABAKVICTORIA HAABAKVICTORIA HAABAK
Position of compensated person
Current individual trustee or directorTrue TrueTrueTrue
Average hours per week working for org3.00 3.003.003.00
Reportable compensation from org$0.00 $0.00$0.00$0.00
Other comp, non-reportable, from org and related orgs$0.00 $0.00$0.00$0.00
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00 $0.00$0.00$0.00
Jensen, Brandon
TitleDIRECTOR DIRECTOR  
Name of key/compensated personBRANDON JENSEN BRANDON JENSEN  
Position of compensated person
Current individual trustee or directorTrue True  
Average hours per week working for org3.00 3.00  
Reportable compensation from org$0.00 $0.00  
Other comp, non-reportable, from org and related orgs$0.00 $0.00  
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00 $0.00  
Johnson, Ryan
Title  DIRECTORDIRECTORDIRECTOR
Name of key/compensated person  RYAN JOHNSONRYAN JOHNSONRYAN JOHNSON
Position of compensated person
Current individual trustee or director  TrueTrueTrue
Average hours per week working for org  3.003.003.00
Reportable compensation from org  $0.00$0.00$0.00
Other comp, non-reportable, from org and related orgs  $0.00$0.00$0.00
Corresponding comp from related orgs
Reportable compensation from related orgs   $0.00$0.00$0.00
Lundeby, Brandon
TitleDIRECTOR DIRECTORDIRECTOR 
Name of key/compensated personBRANDON LUNDEBY BRANDON LUNDEBYBRANDON LUNDEBY 
Position of compensated person
Current individual trustee or directorTrue TrueTrue 
Average hours per week working for org3.00 3.003.00 
Reportable compensation from org$0.00 $0.00$0.00 
Other comp, non-reportable, from org and related orgs$0.00 $0.00$0.00 
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00 $0.00$0.00 
Oxton, Ranae
TitleDIRECTOR SECRETARY/TREASURERSECRETARY/TREASURERSECRETARY/TREASURER
Name of key/compensated personRANAE OXTON RANAE OXTONRANAE OXTONRANAE OXTON
Position of compensated person
Current individual trustee or directorTrue TrueTrueTrue
Current officer  TrueTrueTrue
Average hours per week working for org3.00 5.005.005.00
Reportable compensation from org$0.00 $0.00$0.00$0.00
Other comp, non-reportable, from org and related orgs$0.00 $0.00$0.00$0.00
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00 $0.00$0.00$0.00
Stein, Heather
TitleSECRETARY/TREASURER    
Name of key/compensated personHEATHER STEIN    
Position of compensated person
Current individual trustee or directorTrue    
Current officerTrue    
Average hours per week working for org5.00    
Reportable compensation from org$0.00    
Other comp, non-reportable, from org and related orgs$0.00    
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00    
Swenson, Catherine
TitleCEO    
Name of key/compensated personCATHERINE SWENSON    
Position of compensated person
Current officerTrue    
Average hours per week working for org40.00    
Reportable compensation from org$81,362.00    
Other comp, non-reportable, from org and related orgs$2,009.00    
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00    
Swenson, Cathy
Title   CEOCEO
Name of key/compensated person   CATHY SWENSONCATHY SWENSON
Position of compensated person
Current officer   TrueTrue
Average hours per week working for org   40.0040.00
Reportable compensation from org   $78,717.00$73,445.00
Other comp, non-reportable, from org and related orgs   $6,748.00$6,474.00
Corresponding comp from related orgs
Reportable compensation from related orgs    $0.00$0.00
Twete, Angie
TitleDIRECTOR    
Name of key/compensated personANGIE TWETE    
Position of compensated person
Current individual trustee or directorTrue    
Average hours per week working for org3.00    
Reportable compensation from org$0.00    
Other comp, non-reportable, from org and related orgs$0.00    
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00    
Twete, Judy
TitlePRESIDENT PRESIDENTPRESIDENTPRESIDENT
Name of key/compensated personJUDY TWETE JUDY TWETEJUDY TWETEJUDY TWETE
Position of compensated person
Current individual trustee or directorTrue TrueTrueTrue
Current officerTrue TrueTrueTrue
Average hours per week working for org5.00 5.005.005.00
Reportable compensation from org$0.00 $0.00$0.00$0.00
Other comp, non-reportable, from org and related orgs$0.00 $0.00$0.00$0.00
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00 $0.00$0.00$0.00
Wixo, Tony
Title  DIRECTORVICE PRESIDENTVICE PRESIDENT
Name of key/compensated person  TONY WIXOTONY WIXOTONY WIXO
Position of compensated person
Current individual trustee or director  TrueTrueTrue
Current officer   TrueTrue
Average hours per week working for org  3.005.005.00
Reportable compensation from org  $0.00$0.00$0.00
Other comp, non-reportable, from org and related orgs  $0.00$0.00$0.00
Corresponding comp from related orgs
Reportable compensation from related orgs   $0.00$0.00$0.00
Purpose: mission, activities, & accomplishments
Mission or significant activitiesPROMOTION OF HEALTH CARE THROUGH THE OPERATION OF A 19-BED HOSPITAL AND CLINIC. PROMOTION OF HEALTH CARE THROUGH THE OPERATION OF A 19-BED HOSPITAL AND CLINIC.PROMOTION OF HEALTH CARE THROUGH THE OPERATION OF A 19-BED HOSPITAL AND CLINIC.PROMOTION OF HEALTH CARE THROUGH THE OPERATION OF A 19-BED HOSPITAL AND CLINIC.
Program service expenses, total$1,915,070.00 $2,052,441.00$1,949,146.00$2,088,915.00
Programs, including revenue & expenses
NELSON COUNTY HEALTH SYSTEM IS A 19 BED CRITICAL ACCESS HOSPITAL LOCATED IN NELSON COUNTY FOR ACUTE, OBSERVATION, EMERGENCY ROOM AND SWING BED SERVICES. THE HOSPITAL PROVIDES NEEDED MEDICAL CARE TO THE COMMUNITY REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY.
Program expenses$1,915,070.00 $2,052,441.00$1,949,146.00$2,088,915.00
Program revenue$2,338,113.00 $2,277,531.00$2,102,514.00$2,209,896.00
Program descriptionNELSON COUNTY HEALTH SYSTEM IS A 19 BED CRITICAL ACCESS HOSPITAL LOCATED IN NELSON COUNTY FOR ACUTE, OBSERVATION, EMERGENCY ROOM AND SWING BED SERVICES. THE HOSPITAL PROVIDES NEEDED MEDICAL CARE TO THE COMMUNITY REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. NELSON COUNTY HEALTH SYSTEM IS A 19 BED CRITICAL ACCESS HOSPITAL LOCATED IN NELSON COUNTY FOR ACUTE, OBSERVATION, EMERGENCY ROOM AND SWING BED SERVICES. THE HOSPITAL PROVIDES NEEDED MEDICAL CARE TO THE COMMUNITY REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY.NELSON COUNTY HEALTH SYSTEM IS A 19 BED CRITICAL ACCESS HOSPITAL LOCATED IN NELSON COUNTY FOR ACUTE, OBSERVATION, EMERGENCY ROOM AND SWING BED SERVICES. THE HOSPITAL PROVIDES NEEDED MEDICAL CARE TO THE COMMUNITY REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY.NELSON COUNTY HEALTH SYSTEM IS A 19 BED CRITICAL ACCESS HOSPITAL LOCATED IN NELSON COUNTY FOR ACUTE, OBSERVATION, EMERGENCY ROOM AND SWING BED SERVICES. THE HOSPITAL PROVIDES NEEDED MEDICAL CARE TO THE COMMUNITY REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY.
Financial data
Revenue
Total revenue$2,781,267.00 $2,835,699.00$2,575,914.00$2,945,961.00
Revenue from contributions (total)$56,895.00$141,844.00$86,940.00$198,339.00$490,852.00
Investment income, current yr$678.00 -$605.00$441.00$160.00
Total revenue from grants, etc., current yr$56,895.00 $86,940.00$198,339.00$490,852.00
Total unrelated business revenue$0.00 $0.00$0.00$0.00
Other revenue, current yr$385,581.00 $471,833.00$274,620.00$245,053.00
Net unrelated business taxable revenue$0.00 $0.00$0.00$0.00
Program service revenue (total)$2,338,113.00$2,332,834.00$2,277,531.00$2,102,514.00$2,209,896.00
Gross receipts$2,796,823.00 $2,836,699.00$2,575,914.00$2,945,961.00
Sources of contributions
Revenue from gov't grants  $23,243.00$83,356.00$268,678.00
Revenue from all other contributions$56,895.00 $63,697.00$114,983.00$222,174.00
Other types of revenue
Miscellaneous revenue (total)$385,581.00 $471,833.00$274,620.00$245,053.00
Income from dividends, interest, and similar investments$234.00 $395.00$441.00$160.00
Net rental income -$752.00$0.00$0.00$0.00
Expense categories (totals)
Total functional expenses: sum of all$2,643,610.00 $2,815,582.00$2,535,339.00$2,636,865.00
Total functional expenses: program service $1,915,070.00 $2,052,441.00$1,949,146.00$2,088,915.00
Total functional expenses: management and general$728,540.00 $763,141.00$586,193.00$547,950.00
Total functional expenses: fundraising$0.00 $0.00$0.00$0.00
Fees for services
Fundraising service fees (total)$0.00 $0.00$0.00$0.00
Assets and liabilities
Total assets$1,620,754.00$1,578,848.00$1,262,899.00$1,440,601.00$1,146,741.00
Total assets, beginning of year$1,578,848.00 $1,440,601.00$1,146,741.00$1,066,145.00
Total liabilities$508,793.00$604,544.00$683,504.00$881,323.00$628,038.00
Total liabilities, beginning of year$604,544.00 $881,323.00$628,038.00$856,538.00
Pledges & accounts receivable, net$0.00  $31,359.00$18,117.00
Unrestricted net assets, end of yr$1,111,961.00 $579,395.00$559,278.00$518,703.00
Net assets$1,111,961.00 $579,395.00$559,278.00$518,703.00
Net assets, beginning of year$974,304.00 $559,278.00$518,703.00$209,607.00
Other liabilities$231,252.00 $182,952.00$133,827.00$175,329.00
Other assets$831,929.00 $653,018.00$665,195.00$393,555.00
Cash: non-interest bearing$63.00 $139.00$157.00$150.00
Cash: non-interest bearing, beginning of year$55.00 $157.00$150.00$150.00
Inventories for sale or use$48,757.00 $35,608.00$35,755.00$37,596.00
Other financial variables
Revenue less expenses$137,657.00 $20,117.00$40,575.00$309,096.00
Advertising (total)$3,003.00 $2,557.00$3,740.00$3,241.00
Savings & temp cash investment$141,468.00 $127,155.00$218,073.00$195,741.00
Accounts receivable, net$375,541.00 $227,632.00$242,010.00$293,383.00
Prepaid expenses & deferred charges$96,703.00 $105,747.00$97,796.00$41,527.00
Accounts payable & accrued expenses$91,145.00 $254,383.00$466,684.00$452,709.00
Secured mortgages and notes payable$186,396.00 $246,169.00$280,812.00$0.00
Total net assets or fund balances$1,111,961.00 $579,395.00$559,278.00$518,703.00
Depreciation, depletion, amortization$37,154.00 $54,235.00$48,375.00$47,589.00
Governance and accountability
Number of voting members8 787
Number of independent voting members7 676
Financial sheets auditedTrue TrueTrueTrue
Audit on consolidated basisTrue TrueTrue 
Accrual accountingTrue TrueTrueTrue
Tax year start date2015-07-01 2013-07-012012-07-012011-07-01
Tax year end date2016-06-012015-06-012014-06-012013-06-012012-06-01
Indicators for schedules (selected)
Attached copy of audited financialsTrue TrueTrueTrue
Operate hospital facilitiesTrue TrueTrueTrue
Hospital data
Facility count1 111
Hospital facilities
NELSON COUNTY HEALTH SYSTEM-HOSPITAL
Facility nameNELSON COUNTY HEALTH SYSTEM-HOSPITAL NELSON COUNTY HEALTH SYSTEM-HOSPITALNELSON COUNTY HEALTH SYSTEM-HOSPITALNELSON COUNTY HEALTH SYSTEM-HOSPITAL
Facility line number1 111
Address 200 N MAIN ST 200 N MAIN ST200 N MAIN ST200 N MAIN ST
StateND NDNDND
Zip code58254 582545825458254
Type(s) of facility
Licensed facilityTrue TrueTrueTrue
Critical access hospitalTrue TrueTrueTrue
ER - 24 hoursTrue TrueTrueTrue
Community benefits and community building
Has financial assistance policyTrue TrueTrueTrue
Provide discounts to medically indigentTrue True  
Medicaid, net community benefit expense$17,749.00 $21,039.00$46,943.00$59,368.00
Medicaid, percent of total expense$0.01 $0.01$0.02$0.02
Community health improvement, net community benefit expense$4,320.00 $4,400.00$4,525.00$4,525.00
Community health improvement, percent of total expense$0.00 $0.00$0.00$0.00
Total benefits, net community benefit expense$22,069.00 $25,439.00$51,468.00$63,893.00
Total community benefits as percent of total expense$0.01 $0.01$0.02$0.02
Bad debt expense$93,444.00 $55,867.00$775.00$21,130.00
Bad debt due to charity    $0.00
Revenue from Medicare$1,576,335.00 $1,518,718.00$1,311,601.00$1,261,457.00
Medicare allowable costs$1,576,335.00  $1,311,601.00$1,261,457.00
Medicare surplus or shortfall  $1,518,718.00  
Metadata about the filing
E-return type: 990, 990EZ, or 990PF990 990990990
Date e-filing submitted2017-04-18 2015-02-242014-04-072013-02-26
IRS schema version2015v2.1 2013v4.02012v2.12011v1.2
Filing identifier201603479349301350 201510419349301211201400439349301535201320389349300937
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