Walhalla Community Hospital Association, Pembilier Nursing Center in Walhalla, North Dakota (ND)

Walhalla Community Hospital Association, Pembilier Nursing Center
Employer Identification Number (EIN)	450278093
Name of Organization	Walhalla Community Hospital Association
Secondary Name	Pembilier Nursing Center
Address	500 Delano Ave, Walhalla, ND 58282-4637
Activities	Hospital
Subsection	Charitable Organization
Ruling Date	11/1964
Deductibility	Contributions are deductible
Foundation	Hospital or medical research organization
Organization	Corporation
Exempt Organization Status	Unconditional Exemption
Tax Period	06/2014
Assets	$1,000,000 to $4,999,999
Income	$1,000,000 to $4,999,999
Filing Requirement	990 (all other) or 990EZ return
Asset Amount	$1,602,439
Amount of Income	$2,438,034
Form 990 Revenue Amount	$2,424,318

Non-representatives - add comments:

Financial snapshot ($)

Revenue for 2014

Assets at the end of 2014

Functional expenses for 2014

Support schedule

	2013	2014
Checklist
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)?	Yes	Yes
Is the organization required to complete Schedule B, Schedule of Contributors?	Yes	No
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office?	No	No
Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year?	No	No
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19?	No	No
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts?	No	No
Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas, or historic structures?	No	No
Did the organization maintain collections of works of art, historical treasures, or other similar assets?	No	No
Did the organization report an amount for escrow or custodial account liability; serve as a custodian or provide credit counseling, debt management, credit repair, or debt negotiation services?	Yes	Yes
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments?	No	No
Did the organization report an amount for land, buildings, and equipment?	Yes	Yes
Did the organization report an amount for investments-other securities that is 5% or more of its total assets?	No	No
Did the organization report an amount for investments-program related that is 5% or more of its total assets?	No	No
Did the organization report an amount for other assets that is 5% or more of its total assets?	No	No
Did the organization report an amount for other liabilities?	No	Yes
Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses the organization's liability for uncertain tax positions under FIN 48 (ASC 740)?	Yes	Yes
Did the organization obtain separate, independent audited financial statements for the tax year?	Yes	Yes
Was the organization included in consolidated, independent audited financial statements for the tax year?	No	No
Is the organization a school described in section 170(b)(1)(A)(ii)?	No	No
Did the organization maintain an office, employees, or agents outside of the United States?	No	No
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more?	No	No
Did the organization report more than $5,000 of grants or other assistance to or for any foreign organization?	No	No
Did the organization report more than $5,000 of aggregate grants or other assistance to or for foreign individuals?	No	No
Did the organization report a total of more than $15,000 of expenses for professional fundraising services?	No	No
Did the organization report more than $15,000 total of fundraising event gross income and contributions?	No	No
Did the organization report more than $15,000 of gross income from gaming activities?	No	No
Did the organization operate one or more hospital facilities?	No	No
Did the organization attach a copy of its audited financial statements?	No	No
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government?	No	No
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals?	No	No
Did the organization answer 'Yes' about compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees?	No	No
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002?	No	No
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?	No	No
Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt bonds?	No	No
Did the organization act as an 'on behalf of' issuer for bonds outstanding at any time during the year?	No	No
Did the organization engage in an excess benefit transaction with a disqualified person during the year?	No	No
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ?	No	No
Did the organization report any amount for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons?	No	No
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons?	No	No
Was the organization a party to a business transaction with one of the following parties
A current or former officer, director, trustee, or key employee?	No	No
A family member of a current or former officer, director, trustee, or key employee?	No	No
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner?	No	No
Did the organization receive more than $25,000 in non-cash contributions?	No	No
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions?	No	No
Did the organization liquidate, terminate, or dissolve and cease operations?	No	No
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets?	No	No
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3?	No	No
Was the organization related to any tax-exempt or taxable entity?	No	No
Did the organization have a controlled entity within the meaning of section 512(b)(13)?	No	No
Did the organization make any transfers to an exempt non-charitable related organization?	No	No
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes?	No	No

	2012	2013	2014
Statements Regarding Other IRS Filings and Tax Compliance
The number reported in Box 3 of Form 1096		5	5
The number of Forms W-2G		0	0
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners?		Yes	Yes
The number of employees reported on Form W-3, Transmittal of Wage and Tax Statements, filed for the calendar year ending with or within the year covered by this return		64	63
Did the organization file all required federal employment tax returns?		Yes	Yes
Did the organization have unrelated business gross income of $1,000 or more during the year?	No	No	No
Has it filed a Form 990-T for this year?		No	No
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?		No	No
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?		No	No
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?		No	No
Did the organization file Form 8886-T?		No	No
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?		No	No
Did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?		No	No
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?		No	No
Did the organization notify the donor of the value of the goods or services provided?		No	No
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?		No	No
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?		No	No
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?		No	No
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?		No	No
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?		No	No
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year?		No	No
Did the sponsoring organization make any taxable distributions under section 4966?		No	No
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?		No	No
Initiation fees and capital contributions	$0	$0	$0
Gross receipts for public use of club facilities	$0	$0	$0
Gross income from members or shareholders	$0	$0	$0
Gross income from other sources	$0	$0	$0
Is the organization filing Form 990 in lieu of Form 1041?		No	No
The amount of tax-exempt interest received or accrued during the year		$0	$0
Is the organization licensed to issue qualified health plans in more than one state?		No	No
The amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans		$0	$0
The amount of reserves on hand		$0	$0
Did the organization receive any payments for indoor tanning services during the tax year?		No	No
Has it filed a Form 720 to report these payments?		No	No

	2013	2014
Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
Total reportable compensation from the organization	$35,218	$37,258
Total reportable compensation from related organizations	$0	$0
Total estimated amount of other compensation from the organization and related organizations	$1,456	$1,456
Total number of individuals who received more than $100,000 of reportable compensation from the organization	0	0
Total number of independent contractors who received more than $100,000 of compensation from the organization	1	1

	2012	2013	2014
Statement of Revenue
Total revenue	$2,085,102	$2,282,110	$2,424,318
Contributions, Gifts, Grants and Other Similar Amounts	$38,677	$52,981	$52,484
Program Service Revenue	$2,041,776	$2,174,589	$2,369,576
623310		$2,008,548	$2,166,049
Assisted Living Facilities for the Elderly		$162,101	$200,073
900099		$3,940	$3,454
All other program service revenue		$0	$0
Other Revenue
Investment income (including dividends, interest, and other similar amounts)	$1,137	$4,270	$4,379
Income from investment of tax-exempt bond proceeds	$0	$0	$0
Royalties	$0	$0	$0
Net rental income	$0	$0	$0
Net gain/loss from sales of assets other than inventory	$438	$47,100	$-9,417
Gross amount from sales of assets other than inventory (Securities / Other)	$0 / $438	$0 / $47,100	$0 / $2,237
Less: cost or other basis and sales expenses (Securities / Other)	$0 / $0	$0 / $0	$0 / $11,654
Gain or (loss) (Securities / Other)	$0 / $438	$0 / $47,100	$0 / $-9,417
Net income/loss from fundraising events	$0	$-253	$3,875
Gross income from fundraising events	$0	$5,611	$5,937
Less: direct expenses	$0	$5,864	$2,062
Net income/loss from gaming activities	$0	$0	$0
Net income/loss from sales of inventory	$0	$0	$0
Miscellaneous Revenue	$3,074	$3,423	$3,421
900099		$3,423	$3,421
All other revenue		$0	$0

	2012	2013	2014
Statement of Functional Expenses
Total functional expenses	$2,019,619	$2,129,674	$2,357,256
Grants and other assistance to domestic organizations and domestic governments		$0	$0
Grants and other assistance to domestic individuals		$0	$0
Grants and other assistance to foreign organizations, foreign governments, and foreign individuals		$0	$0
Benefits paid to or for members		$0	$0
Compensation of current officers, directors, trustees, and key employees	$36,469	$35,817	$41,837
Compensation not included above, to disqualified persons		$0	$0
Other salaries and wages	$915,485	$1,012,920	$1,162,355
Pension plan accruals and contributions		$1,627	$500
Other employee benefits		$108,245	$86,686
Payroll taxes	$72,468	$78,683	$90,397
Fees for services (non-employees)
Management		$176,795	$182,162
Legal		$21,856	$1,394
Accounting		$17,070	$17,780
Lobbying		$0	$0
Professional fundraising services	$0	$0	$0
Investment management fees		$0	$0
Other		$98,177	$120,444
Advertising and promotion		$8,463	$8,842
Office expenses		$129,552	$192,316
Information technology		$15	$0
Royalties		$0	$0
Occupancy		$75,119	$83,404
Travel		$11,079	$16,074
Payments of travel or entertainment expenses for any federal, state, or local public officials		$0	$0
Conferences, conventions, and meetings		$4,218	$4,844
Interest		$30,938	$23,558
Payments to affiliates		$0	$0
Depreciation, depletion, and amortization		$125,383	$133,485
Insurance		$37,023	$37,337
Other expenses		$109,439	$114,435
Other expenses		$16,092	$16,359
Other expenses		$3,535	$9,000
Other expenses		$0	$1,717
Other expenses		$27,628	$12,330

	2012	2013	2014
Balance Sheet
Total assets	$1,479,993	$1,569,391	$1,602,439
Cash - non-interest-bearing		$0	$0
Savings and temporary cash investments		$148,034	$233,009
Pledges and grants receivable, net		$0	$0
Accounts receivable, net		$154,911	$134,947
Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees		$0	$0
Loans and other receivables from other disqualified persons, persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations		$0	$0
Notes and loans receivable, net		$0	$0
Inventories for sale or use		$14,337	$16,628
Prepaid expenses and deferred charges		$17,576	$15,005
Land, buildings, and equipment: cost or other basis		$1,076,546	$1,044,327
Investments - publicly traded securities		$157,987	$158,523
Investments - other securities		$0	$0
Investments - program-related		$0	$0
Intangible assets		$0	$0
Other assets		$0	$0
Total liabilities	$618,735	$555,585	$523,275
Accounts payable and accrued expenses		$123,218	$151,990
Grants payable		$0	$0
Deferred revenue		$0	$0
Tax-exempt bond liabilities	$0	$0	$0
Escrow or custodial account liability		$9,279	$11,092
Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified persons		$0	$0
Secured mortgages and notes payable to unrelated third parties	$476,145	$423,088	$348,514
Unsecured notes and loans payable to unrelated third parties	$0	$0	$0
Other liabilities (including federal income tax, payables to related third parties, and other liabilities)		$0	$11,679
Total net assets or fund balances	$861,258	$1,013,806	$1,079,164
Unrestricted net assets		$1,013,806	$1,079,164
Temporarily restricted net assets		$0	$0
Permanently restricted net assets		$0	$0
Capital stock or trust principal, or current funds		$0	$0
Paid-in or capital surplus, or land, building, or equipment fund		$0	$0
Retained earnings, endowment, accumulated income, or other funds	$0	$0	$0

Reason for Public Charity Status (for 2014)
The organization is not a private foundation because it is:	An organization that normally receives: (1) more than 33 1/3 % of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions - subject to certain exceptions, and (2) no more than 33 1/3 % of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975
Number of organizations supported	0
Sum of amounts of support	$0

	2010 - 2014 Total
Support Schedule for Organizations Described in Section 509(a)(2) (for 2010 - 2014)
Public support	$5,673,123
Subtotal	$10,589,578
Gifts, grants, contributions, and membership fees received	$236,183
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose	$10,333,251
Gross receipts from activities that are not an unrelated trade or business under section 513	$20,144
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf	$0
The value of services or facilities furnished by a governmental unit to the organization without charge	$0
Less	$4,916,455
Amounts received from disqualified persons	$0
Amounts received from other than disqualified persons that exceed the greater of $5,000 or 1% of the total support	$4,916,455
Total support	$10,602,220
Public support	$10,589,578
Subtotal	$12,642
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources	$12,642
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975	$0
Net income from unrelated business activities, whether or not the business is regularly carried on	$0
Other income	$0

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Id	Name	Address	State	Established	Total Income
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8	Wahpeton Breckenridge Area Chamber Of Commerce	118 6th St N, Wahpeton, ND 58075-4344	ND	1944-12	$191,313
9	Wahpeton Harmony Senior Citizens Club Inc	520 3rd Ave S, Wahpeton, ND 58075-4611	ND	1976-06	$179,310
10	Wahpeton Hockey Association	PO BOX 274, Wahpeton, ND 58074-0274	ND	1990-09	$571,225
11	Walhalla Community Hospital Association, Pembilier Nursing Center	500 Delano Ave, Walhalla, ND 58282-4637	ND	1964-11	$2,438,034
12	Walhalla Country Club	PO BOX 122, Walhalla, ND 58282-0122	ND	1971-03	$183,402
13	Walsh County Farm Bureau	PO BOX 350, Grafton, ND 58237-0350	ND	1978-01	$42,049
14	Walsh County Gun Club	PO BOX 334, Park River, ND 58270-0334	ND	1989-07	$108,347
15	Walsh County Heritage Village	695 W 12th St, Grafton, ND 58237-2115	ND	1985-02	$44,628
16	Walsh County Historical Society	14160 68th St Ne, Grafton, ND 58237-9152	ND	1973-10	$28,030
17	Walsh County Senior Citizens Council	PO BOX 620, Park River, ND 58270-0620	ND	1976-02	$580,540
18	Walter And Barbara E-Reishus- Pedersen Lutheran Foundation	PO BOX 5267, Grand Forks, ND 58206-5267	ND	1986-03	$165,260
19	Wanzek Family Foundation	505 Broadway N Ste 305, Fargo, ND 58102-4487	ND	2009-12	$5,063,303
20	Ward Charitable Trust, Ward Raymond Ttee	PO BOX 6001, Grand Forks, ND 58206-6001	ND	2001-04	$341,985

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