Kootenai Health transitioned from a hospital district to a nonprofit 501(c)(3) organization on January 1, 2024, relinquishing its taxing authority, sovereign immunity, and eminent domain powers. 
Hospital district assets were legally transferred to the new nonprofit, and the existing board became the nonprofit’s initial board of directors.
Despite this shift, Idaho law mandates that the now-nonfunctional Kootenai Hospital District board continue to meet and hold elections. As a result, three trustee seats will appear on the May 20, 2025, ballot. This FAQ provides more information about the election and the current role of the hospital district board.
- Didn’t Kootenai Health become a nonprofit? Why is there still an election?
Yes. Kootenai Health officially transitioned from a hospital district to a 501(c)(3) nonprofit organization on January 1, 2024. However, under Idaho law, the former Kootenai Hospital District board must continue to meet and the Kootenai County Elections office must hold elections until the District is formally dissolved. That’s why three trustee positions will appear on the May 20, 2025, ballot — even though the board no longer has assets, operations, or control of the hospital.
- What powers does the Kootenai Hospital District board still have?
None that impact hospital operations. The district has:
- No staff
- No assets
- No authority over Kootenai Health
Its only remaining theoretical power is the ability to levy a tax, which it has not done since 1995. - The District does still hold two frozen retirement plans that will eventually be terminated.
- Can the nonprofit transition be undone?
No. The transition to a 501(c)(3) nonprofit is legal, final, and irreversible:
- All hospital assets were permanently transferred to the new nonprofit.
- The district no longer owns or governs Kootenai Health.
- There is no legal mechanism for the district board to reclaim control or undo the change.
- Why isn’t the district already dissolved?
Idaho law requires a two-year waiting period after a hospital district ceases operations before it can be dissolved. Kootenai Health plans to request formal dissolution from the Kootenai County Commissioners as soon as the district becomes eligible — January 1, 2026.
- What is the purpose of this election?
While required by law, the election does not affect Kootenai Health’s governance or operations. The outcome will have no impact on the hospital or its nonprofit status.
- What happens after January 1, 2026?
Kootenai Health will formally request that the Kootenai County Commissioners dissolve the non-functioning district, citing its complete lack of purpose or function. Once dissolved, the elections and board meetings will end permanently.
- Why did Kootenai Health make this change in the first place?
Transitioning to a 501(c)(3):
- Strengthens financial sustainability
- Enables greater access to grants, philanthropy, and capital
- Aligns Kootenai Health with the majority of U.S. hospitals, which operate as nonprofits
- Allows for selection of Hospital Directors with needed skill set and experience to oversee the operations of a large and complex hospital system.
