CULBERTSON FROID BAINVILLE HEALTH CARE CORPORATION: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- CULBERTSON FROID BAINVILLE HEALTH CARE CORPORATION (EIN 81-0373589)
- Tax period
- 2022-05-01 to 2023-04-30
- Filed
- 2024-03-08
- IRS object ID
- 202420689349301407
- Schema version
- 2022v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-03-08T12:16:26-05:00 | ReturnTs |
| Tax Period End | 2023-04-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREEN HEALTH GROUP PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 405 FOURTH AVENUE NORTH | AddressLine1Txt |
| City | GLASGOW | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59230 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-05-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810373589 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULBERTSON FROID BAINVILLE | BusinessNameLine1Txt |
| Business Name Line2 | HEALTHCARE CORPORATION | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CULB | BusinessNameControlTxt |
| Phone | 4067876401 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 419 | AddressLine1Txt |
| City | CULBERTSON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59218 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | AUDREY STROMBERG | PersonNm |
| Person Title | ADMINISTRATOR | PersonTitleTxt |
| Phone | 4067876401 | PhoneNum |
| Signature | 2024-03-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | AUDREY | PersonFirstNm |
| Person Last | STROMBERG | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (true) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DANIEL GREEN | PreparerPersonNm |
| PTIN | P01311679 | PTIN |
| Phone | 4062632615 | PhoneNum |
| Preparation | 2024-03-08 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROOSEVELT MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | AUDREY STROMBERG | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 419 | AddressLine1Txt |
| City | CULBERTSON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59218 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $8,677,534 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | ROOSEVELTMEDICAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1976 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | ROOSEVELT MEDICAL CENTER IS DEDICATED TO PROVIDING PATIENTS WITH APPROPRIATE, PERSONALIZED, AND QUALITY HEALTH CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 98 | TotalEmployeeCnt |
| Total Volunteers | 48 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,138,195 | PYContributionsGrantsAmt |
| CY Contributions Grants | $633,350 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $7,748,633 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $7,755,836 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$18,823 | PYInvestmentIncomeAmt |
| CY Investment Income | -$11,814 | CYInvestmentIncomeAmt |
| PY Other Revenue | $253,409 | PYOtherRevenueAmt |
| CY Other Revenue | $300,162 | CYOtherRevenueAmt |
| PY Total Revenue | $9,121,414 | PYTotalRevenueAmt |
| CY Total Revenue | $8,677,534 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,279,793 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,016,987 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $46,259 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,119,382 | PYOtherExpensesAmt |
| CY Other Expenses | $4,222,366 | CYOtherExpensesAmt |
| PY Total Expenses | $8,399,175 | PYTotalExpensesAmt |
| CY Total Expenses | $8,239,353 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $722,239 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $438,181 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $8,917,616 | TotalAssetsBOYAmt |
| Total Assets EOY | $10,132,530 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,394,358 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,705,768 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,523,258 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $8,426,762 | NetAssetsOrFundBalancesEOYAmt |
| Mission | ROOSEVELT MEDICAL CENTER IS DEDICATED TO PROVIDING PATIENTS WITH APPROPRIATE, PERSONALIZED, AND QUALITY HEALTH CARE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $6,914,076 | ExpenseAmt |
| Revenue | $7,755,836 | RevenueAmt |
| Desc | ROOSEVELT MEDICAL CENTER IS DEDICATED TO PROVIDING PATIENTS WITH APPROPRIATE, PERSONALIZED, AND QUALITY HEALTH CARE. | Desc |
| Total Program Service Expenses | $6,914,076 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 11 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 98 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JENNIFER KESSNER | PersonNm |
| Phone | 4067876401 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 419 | AddressLine1Txt |
| City | CULBERTSON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59218 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| DANIELLE CHRISTENSEN | |||||||
| RN | 58.00 | Yes (X) | $180,761 | $0 | $8,460 | ||
| ZOE FUGERE | |||||||
| FNP | 34.00 | Yes (X) | $163,237 | $0 | $8,761 | ||
| JOANN SMITH | |||||||
| LAB MANAGER | 49.00 | Yes (X) | $140,297 | $0 | $8,760 | ||
| AUDREY STROMBERG | |||||||
| ADMINISTRATO | 40.00 | $134,330 | $0 | $8,461 | Yes (X) | ||
| BLAINE WHITE | |||||||
| PA | 35.00 | Yes (X) | $139,942 | $0 | $300 | ||
| JENNIFER KESSNER | |||||||
| CFO | 44.00 | $128,645 | $0 | $8,761 | Yes (X) | ||
| JANET ROYAN | |||||||
| RN | 43.00 | Yes (X) | $123,012 | $0 | $8,055 | ||
| CASSANDRA BERGUM | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| ROBBIE DENT-SAVELKOUL | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| AMBER FOX | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| STEVE LARSEN | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| PAULA SCHLEDEWITZ | |||||||
| CHAIRMAN | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| SHARON SCHMITZ | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| KATHY MCCABE THOMPSON | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,010,224 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $51,558 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MONTANA HEALTH NETWORK INC | |||||
| 519 PLEASANT STREET | MILES CITY | MT | 59301 | NURSING STAFF | $522,545 |
| FOREFRONT HEALTHCARE | |||||
| 22622 HARPER AVENUE | SAINT CLAIRE SHORES | MI | 48080 | DIETARY SVCS | $424,916 |
| MARVEL MEDICAL STAFFING LLC | |||||
| PO BOX 3544 | OMAHA | NE | 68103 | XRAY STAFF | $354,591 |
| TRIAGE LLC | |||||
| PO BOX 773328 | CHICAGO | IL | 606773328 | NURSING STAFF | $149,966 |
| TRUSTED HEALTH INC | |||||
| PO BOX 7775 | SAN FRANCISCO | CA | 941207775 | NURSING STAFF | $132,336 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $63,315 | RelatedOrganizationsAmt |
| Government Grants | $94,437 | GovernmentGrantsAmt |
| All Other Contributions | $475,598 | AllOtherContributionsAmt |
| Total Contributions | $633,350 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT REVENUE | 621500 | $7,314,634 | $7,314,634 |
| MISC REVENUE | 900099 | $441,202 | $441,202 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $7,755,836 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$11,814 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$11,814 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| HOSPITAL DISTRICT SUBSIDY | 900099 | $299,662 | $299,662 |
| GAIN ON DISPOSAL OF ASSETS | 900099 | $500 | $500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $300,162 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,677,534 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,044,184 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $264,656 | TotalAmt |
| Management And General | $264,656 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,225,066 | TotalAmt |
| Program Services | $2,816,760 | ProgramServicesAmt |
| Management And General | $371,099 | ManagementAndGeneralAmt |
| Fundraising | $37,207 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,072 | TotalAmt |
| Program Services | $11,357 | ProgramServicesAmt |
| Management And General | $2,564 | ManagementAndGeneralAmt |
| Fundraising | $151 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $207,801 | TotalAmt |
| Program Services | $163,026 | ProgramServicesAmt |
| Management And General | $42,619 | ManagementAndGeneralAmt |
| Fundraising | $2,156 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $305,392 | TotalAmt |
| Program Services | $246,381 | ProgramServicesAmt |
| Management And General | $55,668 | ManagementAndGeneralAmt |
| Fundraising | $3,343 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,292,322 | TotalAmt |
| Program Services | $2,154,307 | ProgramServicesAmt |
| Management And General | $137,978 | ManagementAndGeneralAmt |
| Fundraising | $37 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,259 | TotalAmt |
| Management And General | $16,259 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $342,225 | TotalAmt |
| Program Services | $222,293 | ProgramServicesAmt |
| Management And General | $119,144 | ManagementAndGeneralAmt |
| Fundraising | $788 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $445 | TotalAmt |
| Program Services | $445 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,423 | TotalAmt |
| Program Services | $24,469 | ProgramServicesAmt |
| Management And General | $4,928 | ManagementAndGeneralAmt |
| Fundraising | $26 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,500 | TotalAmt |
| Program Services | $35,794 | ProgramServicesAmt |
| Management And General | $8,581 | ManagementAndGeneralAmt |
| Fundraising | $125 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $448,578 | TotalAmt |
| Program Services | $360,791 | ProgramServicesAmt |
| Management And General | $86,531 | ManagementAndGeneralAmt |
| Fundraising | $1,256 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,012 | TotalAmt |
| Program Services | $84,461 | ProgramServicesAmt |
| Management And General | $20,257 | ManagementAndGeneralAmt |
| Fundraising | $294 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| REPAIRS & MAINTENANCE | $431,210 | $324,769 | $105,632 | $809 |
| MEDICAL SUPPLIES | $427,519 | $427,519 | ||
| MISC | $43,153 | $39,215 | $3,871 | $67 |
| BED TAX | $35,093 | $35,093 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,627 | TotalAmt |
| Program Services | $2,489 | ProgramServicesAmt |
| Management And General | $4,138 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,239,353 | TotalAmt |
| Program Services | $6,914,076 | ProgramServicesAmt |
| Management And General | $1,279,018 | ManagementAndGeneralAmt |
| Fundraising | $46,259 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,656,863 | BOYAmt |
| EOY | $2,275,474 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $134,993 | BOYAmt |
| EOY | $127,655 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,348,342 | BOYAmt |
| EOY | $1,879,282 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $222,789 | BOYAmt |
| EOY | $207,219 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $186,447 | BOYAmt |
| EOY | $185,898 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $9,670,750 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,870,992 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,146,196 | BOYAmt |
| EOY | $3,799,758 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $221,986 | BOYAmt |
| EOY | $1,657,244 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,917,616 | BOYAmt |
| EOY | $10,132,530 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $870,639 | BOYAmt |
| EOY | $459,296 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $88,542 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,152,090 | BOYAmt |
| EOY | $1,099,795 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,000 | BOYAmt |
| EOY | $146,677 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $133,087 | BOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,394,358 | BOYAmt |
| EOY | $1,705,768 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,516,173 | BOYAmt |
| EOY | $6,975,069 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,085 | BOYAmt |
| EOY | $1,451,693 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,523,258 | BOYAmt |
| EOY | $8,426,762 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,917,616 | BOYAmt |
| EOY | $10,132,530 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $438,181 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $1,465,323 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $339 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $339 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART IV | FormAndLineReferenceDesc |
| Explanation | 0.10 PERCENT OF DUES PAID TO MHA AND 27.29 PERCENT OF DUES PAID TO AHA, WHICH TOTALED 339, WERE USED FOR LOBBYING EXPENSES BY MHA. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,500 | OtherCostOrOtherBasisAmt |
| Book Value | $18,500 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,760,698 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,553,971 | DepreciationAmt |
| Book Value | $3,206,727 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,886,220 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,317,021 | DepreciationAmt |
| Book Value | $569,199 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,332 | OtherCostOrOtherBasisAmt |
| Book Value | $5,332 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,799,758 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| BENEFICIAL INTEREST IN TRUST | $1,451,693 |
| EQUITY IN AIR AMBULANCE CO-OP | $140,551 |
| EQUITY IN WORKERS' COMP TRUST | $65,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,657,244 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $8,677,534 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $8,677,534 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $8,677,534 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $8,239,353 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $8,239,353 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $8,239,353 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 3, PART X | FormAndLineReferenceDesc |
| Explanation | THE COMPANY BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING THEIR ANNUAL FILING REQUIREMENTS, AND AS SUCH, DO NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $87,892 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $87,892 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01070 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $87,892 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $87,892 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01070 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $156,822 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,105 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $141,717 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01720 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,404,651 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,649,185 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $755,466 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09170 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,561,473 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,664,290 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $897,183 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10890 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,649,365 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,664,290 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $985,075 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11960 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Reimbursed By Medicare | $2,840,569 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $2,862,201 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$21,632 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROOSEVELT MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 419 | AddressLine1Txt |
| City | CULBERTSON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59218 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROOSEVELT MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 20 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | ROOSEVELTMEDICAL.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 20 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | ROOSEVELTMEDICAL.ORG | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.ROOSEVELTMEDICAL.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.ROOSEVELTMEDICAL.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.ROOSEVELTMEDICAL.ORG | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, ROOSEVELT MEDICAL CENTER - PART V, LINE 3E | THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND ARE IDENTIFIED THROUGH THE CHNA. |
| FACILITY 1, ROOSEVELT MEDICAL CENTER - PART V, LINE 5 | A STEERING COMMITTEE WAS CONVENED IN SEPTEMBER 2020 TO ASSIST ROOSEVELT MEDICAL CENTER IN CONDUCTING THE CHNA. IN OCTOBER AND NOVEMBER 2020, TEN KEY INFORMANT INTERVIEWS WERE FACILITATED BY A REPRESENTATIVE WITH THE MONTANA OFFICE OF RURAL HEALTH. THE STEERING COMMITTEE AND KEY INFORMANTS INCLUDED A DIVERSE GROUP OF MEMBERS WHICH REPRESENTED VARIOUS ORGANIZATIONS AND POPULATIONS WITHIN THE COMMUNITY SUCH AS PUBLIC HEALTH, MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY CITIZENS, SENIORS, YOUTH, AND TRIBAL/AMERICAN INDIANS. ALSO, IN OCTOBER 2020, A SURVEY WAS MAILED TO 800 RANDOMLY SELECTED RESIDENTS IN THE HOSPITAL'S SERVICE AREA TO SOLICIT THEIR INPUT. THERE WAS A 20.6 PERCENT RESPONSE. |
| FACILITY 1, ROOSEVELT MEDICAL CENTER - PART V, LINE 11 | THE PRIORITIZED HEALTH NEEDS AS DETERMINED THROUGH THE ASSESSMENT PROCESS AND WHICH THE FACILITY WILL BE ADDRESSING RELATES TO THE FOLLOWING HEALTHCARE ISSUES: 1. SENIOR SERVICES 2. HEALTH AND WELLNESS 3. MENTAL AND BEHAVIORAL HEALTH THE FIRST HEALTHCARE ISSUE IS TO ENHANCE SENIOR SERVICES AVAILABLE IN EASTERN ROOSEVELT COUNTY. ONE STRATEGY FOR ADDRESSING THIS ISSUE IS TO EXPAND SERVICES THAT HELP THE LOCAL SENIOR POPULATION TO AGE IN PLACE SUCH AS EXPLORING OFFERING A FOOT CARE CLINIC AND CHECKING IMMUNIZATION STATUS FOR AREA SENIORS, DETERMINING FEASIBILITY OF IMPLEMENTING A COMMUNITY HEALTH WORKER SERVICE OR COMMUNITY PARAMEDICINE MODEL TO ASSIST SENIORS AND COMMUNITY MEMBERS IN THEIR HOMES, CONTINUING PARTNERSHIP WITH MONTANA HEALTH NETWORK TO DISCUSS THEIR NEW GRANT WORKING TO OFFER IN-HOME SERVICES TO SENIORS AT A SIGNIFICANTLY REDUCED COST, AND RMC WILL PROVIDE/SPONSOR LUNCH AND LEARNS IN COLLABORATION WITH AREA SENIOR CENTERS REGARDING VARIOUS HEALTH TOPICS. THE SECOND STRATEGY IS TO IMPROVE AWARENESS AND REACH OF THE CHRONIC CARE MANAGEMENT PROGRAM BY EXPANDING CURRENT EFFORTS BY CONNECTING WITH THE NEW MONTANA HEALTH NETWORK REGIONAL COORDINATOR AND REACHING OUT TO THE LOCAL SENIOR CENTER TO CONDUCT OUTREACH AND EDUCATION RELATED TO THE CHRONIC CARE MANAGEMENT PROGRAM. DUE TO CLINIC STAFFING ISSUES, FOOT CARE CLINICS/IMMUNIZATIONS WERE NOT FEASIBLE AT THE SENIOR CENTERS. EFFORTS WERE MADE TO PARTNER WITH THE COUNTY'S AGING SERVICES. HOWEVER, THEY TOO HAVE A STAFFING/VOLUNTEER ISSUE. HOWEVER, EDUCATIONAL MATERIALS MORE SPECIFIC TO SENIORS SUCH AS THE BENEFITS OF VACCINES, HEALTHY AGING AND SENIOR AGE-RELATED HEALTH CONCERNS AND TOPICS WERE MADE AVAILABLE AT THE SENIOR CENTERS IN THE COMMUNITIES OF CULBERTSON, BAINVILLE, AND FROID THROUGHOUT THE YEAR. CONDUCTING ON-SITE LUNCH AND LEARNS AT THE SENIOR CENTERS DURING THEIR SHORT HOURS OF OPERATION DURING THE LUNCH MEAL HAVE NOT BEEN POSSIBLE DUE TO STAFFING ISSUES/SCHEDULES. INSTEAD, AWARENESS BROCHURES, POSTERS, AND INFORMATION HAVE BEEN MADE AVAILABLE AT THE SENIOR CENTERS TO COINCIDE WITH MONTHLY HEALTH AWARENESS SPOTLIGHTS. THE CHRONIC CARE MANAGEMENT PROGRAM CONTINUES TO GAIN MOMENTUM WITH OVER A DOZEN AREA SENIORS BENEFITTING FROM THE PROGRAM. PROVIDING INFORMATION ABOUT THE PROGRAM TO THE COMMUNITY IS ONGOING. THE SECOND HEALTHCARE ISSUE IS TO ENHANCE HEALTH, WELLNESS, AND PREVENTION OUTREACH IN EASTERN ROOSEVELT COUNTY. ONE STRATEGY FOR ADDRESSING THIS ISSUE IS TO CONTINUE RMC'S PROMOTION OF HEALTH AND WELLNESS EFFORTS IN CULBERTSON AND THE SURROUNDING AREA BY OFFERING A COMMUNITY HEALTH FAIR, CONTINUING ANNUAL HEALTH SCREENING LABS, AND CONTINUING TO PROMOTE AND SPONSOR COMMUNITY HEALTH AND WELLNESS ACTIVITIES. THE SECOND STRATEGY IS TO GROW RMC'S PRESENCE IN THE COMMUNITY AS A SOURCE FOR HEALTH EDUCATION, OUTREACH, AND RESOURCES BY ENHANCING EDUCATIONAL RESOURCES AND OUTREACH TO THE COMMUNITY REGARDING HEALTH, WELLNESS, AND PREVENTION SUCH AS PROMOTING MONTHLY WELLNESS TOPICS, PROVIDING EDUCATION MATERIALS AT SCHOOL FUNCTIONS AND COMMUNITY EVENTS, AND SPONSORSHIP OF THE K-12 HEALTH BAGS. ANOTHER ACTIVITY FOR THE SECOND STRATEGY MAY INCLUDE PUBLISHING AN ANNUAL HEALTH AND WELLNESS NEWSLETTER. RMC DISTRIBUTED INFORMATIONAL AND FUN BAGS FILLED WITH GOODIES AND HEALTH TIPS TO THE ENTIRE STUDENT POPULATION BEFORE THE END OF THE SCHOOL YEAR. A TEDDY BEAR CLINIC WAS HELD WHICH IS DESIGNED TO ADDRESS A CHILD'S CONCERNS OR FEARS OVER CLINIC VISITS AND ROUTINE MEDICAL PROCEDURES. A PINK NORSKIES AND TACOS NIGHT, MATERIALS LEFT AT AREA POST OFFICES, SOCIAL MEDIA POSTS, AND A PINK PUMPKIN CONTEST WERE ACTIVITIES TO PROMOTE BREAST CANCER AWARENESS. A WINTER SHOWCASE BOOTH WAS SET UP TO PROMOTE HEALTHLY HOLIDAY EATING. ALSO, EACH MONTH RMC HELD A CAMPAIGN VIA SOCIAL MEDIA AND GIVEAWAYS AT DESIGNATED COMMUNITY LOCATIONS TO RAISE AWARENESS FOR VARIOUS HEALTH TOPICS. THROUGHOUT THE YEAR, MONTHLY NATIONAL AWARENESS CAMPAIGNS WERE HIGHLIGHTED VIA SOCIAL MEDIA AND AWARENESS INFORMATION WAS DISSEMINATED THROUGH THE COMMUNITIES VIA THE LOCAL POST OFFICE/SENIOR CENTERS/AREA BUSINESSES. AS THE COMMUNITY DOES NOT HAVE TRADITIONAL DAILY MEDIA OUTLETS, COMMON PLACES WHERE PEOPLE GATHER ARE UTILIZED TO GET INFORMATION OUT. RMC PARTICIPATED IN A SCHOOL CAREER DAY TO PROMOTE THE OPPORTUNITIES OF PURSUING A HEALTH CAREER WHILE PROVIDING AREA YOUTH WITH HANDS-ON OPPORTUNITIES FOR TRYING TO PERFORM CPR AND IDENTIFY ANATOMY. PROVIDERS AND STAFF, IN COLLABORATION WITH THE COUNTY'S TABACCO PREVENTIONIST ATTENDED LOCAL PARENT/TEACHER CONFERENCES AND SET UP BOOTHS WITH AWARENESS INFORMATION. A COMMUNITY HEALTH FAIR WAS HELD IN CONJUNCTION WITH THE ROOSEVELT COUNTY FAIR WITH A DOZEN STAFF IN ATTENDANCE. A SEPARATE EDUCATIONAL BOOTH WAS SET UP TO PROMOTE THE IMPORTANCE OF STAYING HEALTHY BY DEVELOPING A TRUSTING RELATIONSHIP WITH YOUR PRIMARY CARE PROVIDER. DURING THE SUMMER BASEBALL/SOFTBALL SEASON, RMC PARTNERED TO AID DURING THE GAMES WITH THE SNACK SHACK TO PROMOTE HEALTHY, ACTIVE, OUTDOOR ACTIVITIES. STAFF PARTNERED WITH CULBERTSON SCHOOL FOR THE ANNUAL PACK THE GYM IN PINK BREAST CANCER AWARENESS NIGHT IN OCTOBER. FLU VACCINE COLORING BOOKS WERE DISSEMINATED TO AREA ELEMENTARY SCHOOLS (GRADES K-5) SHOWCASING THE CDC READY WRIGLEY COLORING BOOKS. END-OF-YEAR "HEALTHY SUMMER" BAGS WERE PROVIDED TO AREA STUDENTS. SENIOR GRADUATION HEALTH BAGS WERE PROVIDED TO ALL 12TH GRADE GRADUATES WITH INFORMATION ON HEALTHY, LIFESTYLE CHOICES AS THEY MOVE INTO ADULTHOOD AND INDEPENDENT DECISION MAKING. A HAUNTED HALLOWEEN HOSPITAL WAS HOSTED BY STAFF TO PROVIDE AREA YOUTH A SAFE PLACE TO CELEBRATE HALLOWEEN. THERE, EDUCATIONAL STEM ACTIVITIES TOOK PLACE AND SAFETY/WELLNESS AWARENESS WAS PROMOTED. STAFF PARTICIPATED IN THE ANNUAL WINTER SHOWCASE WHERE HEALTHY WINTER LIVING TIPS WERE PROMOTED THROUGH EDUCATION AND GIVEAWAYS. STAFF ALSO SHOWCASED PARADE FLOATS THROUGH SUMMER/WINTER CELEBRATIONS TO PROMOTE HEALTH AND WELLNESS. IN COLLABORATION WITH CULBERTSON SCHOOL, WE HAVE IMPLEMENTED OUR FIRST EMS CLASS AS AN OPPORTUNITY FOR YOUTH INTERESTED IN HEALTH CARE. SEPARATELY, EMS HAS HOSTED CPR TRAINING FOR SCHOOL COACHES AND BUS DRIVERS. EMS ALSO PROVIDES STAND-BY AMBULANCES AT ALL HOME VARSITY FOOTBALL GAMES AND SUMMER EVENTS SUCH AS RODEOS AND STREET DANCES. EMS ALSO VISITS LOCAL DAYCARE FACILITIES FOR AWARENESS ABOUT WHEN TO CALL 9-1-1 AND PROVIDES AMBULANCE TOURS. RMC PARTNERS WITH THE SCHOOL DURING THEIR ANNUAL COLOR RUN. TWICE ANNUALLY, THE LABORATORY PROVIDES WELLNESS LABS SCREENINGS TO THE COMMUNITY. STAFF SERVE AS ACTIVE MEMBERS OF THE CHAMBER OF COMMERCE, LOCAL EMERGENCY PLANNING COMMITTEE, COUNTY EPIDEMIOLOGY COMMITTEE, AND THE CITY'S AIRPORT BOARD. "WELCOME TO TOWN" KITS ARE PROVIDED BY RMC TO AREA TOWN HALLS TO PROMOTE HEALTH AND WELLNESS IN THE AREA TO NEW RESIDENTS. THE THIRD HEALTHCARE ISSUE IS TO IMPROVE ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES IN EASTERN ROOSEVELT COUNTY. THE FIRST STRATEGY FOR ADDRESSING THIS ISSUE IS TO INCREASE COMMUNITY AWARENESS OF NEW AND ENHANCED MENTAL AND BEHAVIORAL HEALTH SERVICES IN THE AREA BY PROVIDING OUTREACH TO THE COMMUNITY ON THE NEW FRONTIER PSYCHIATRY PARTNERSHIP AND AVAILABILITY OF THE NEW TELE-MENTAL HEALTH CAPABILITIES AT RMC AND PROMOTING MENTAL HEALTH SERVICES OFFERED THROUGH THE LICENSED SOCIAL WORKER CANDIDATE AT RMC. THE SECOND STRATEGY IS TO EXPLORE NEW TRAINING OPPORTUNITIES AND PARTNERSHIPS TO ENHANCE THE COMMUNITY'S ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES BY PROMOTING MORH/AHEC'S BEHAVIORAL HEALTH TRAININGS TO RMC STAFF AND AREA PROVIDERS TO ENHANCE MENTAL AND BEHAVIORAL HEALTH SKILLS, KNOWLEDGE, AND TRAINING AND EXPLORING OPPORTUNITIES TO PARTNER WITH LOCAL SCHOOLS, EMS, POLICE, ETC. TO DELIVER SUBSTANCE ABUSE PREVENTION EDUCATION AND PROGRAMMING/EVENTS. OTHER ACTIVITIES FOR THE THIRD STRATEGY MAY INCLUDE MEETING WITH AREA MENTAL HEALTH STAKEHOLDERS TO EXPLORE THE DEVELOPMENT OF A LOCAL MENTAL HEALTH ADVISORY COMMITTEE AND CONNECTING WITH THE NEW LOCAL TOBACCO PREVENTION SPECIALIST TO DEVELOP AND ENHANCE PARTNERSHIP AND EDUCATIONAL OPPORTUNITIES/RESOURCES. A PROVIDER EMPLOYED BY RMC HELD A STRESS LESS FEST WHICH PRESENTED ATTENDEES WITH INFORMATION ON HOW TO REDUCE STRESS AND BALANCE BODY AND MIND. THIS YEAR, RMC HIRED A LICENSED SOCIAL WORKER CANDIDATE TO SEE PATIENTS ON-SITE AND VIRTUALLY THROUGH THE EASTERN MONTANA BEHAVIORAL HEALTH NETWORK. NUMEROUS SERVICE CAMPAIGNS HAVE OCCURRED THROUGHOUT THE YEAR. CURRENTLY, STAFF MEMBERS ARE PART OF THE ROOSEVELT COUNTY/FORT FECK TRIBES CRISES COALITION WHICH MEETS MONTHLY WITH STAKEHOLDERS TO PROMOTE/TACKLE THE ISSUES FACING THE REGION PERTAINING TO THE MENTAL HEALTH AND ADDICTION CRISES. TOGETHER, WE ARE DEVISING PLANS OF ACTION THAT CAN BENEFIT MORE PEOPLE AND GET THEM THE HELP THEY NEED TO LIVE A HEALTHY LIFE. PLANS ARE FOCUSED ON KEEPING PEOPLE OUT OF THE JAIL SYSTEM AND PERPETUAL CYCLES OF ADDICTION AND RELAPSE WHILE ALSO FOCUSING ON SUICIDE PREVENTION. FIVE HEALTH NEEDS ARE IDENTIFIED THA |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROOSEVELT MEDICAL CLINIC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 818 2ND AVE E | AddressLine1Txt |
| City | CULBERTSON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59218 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | RURAL HEALTH CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 7G | THERE IS NO COST OF BAD DEBT TO REMOVE FROM THE COMMUNITY BENEFIT EXPENSE IN COLUMN C. PROVIDER PROFESSIONAL SERVICES MAKE UP 197,154 OF COLUMN C, 137,078 OF COLUMN D, AND 60,076 OF COLUMN E. ROOSEVELT MEDICAL CENTER'S EFFORTS TO RECRUIT AND RETAIN PROVIDERS ARE DEPENDENT ON OUR ABILITY TO COMPETE WITH ALL OTHER COMMUNITIES THAT ARE RECRUITING SIMILAR PROVIDERS. BECAUSE OF OUR SMALL COMMUNITY SIZE AND REMOTE LOCATION FAR REMOVED FROM MEDICAL COMMUNITIES OF GREATER SCOPE, WE EMPLOY PROVIDERS AND SUBSIDIZE THEIR PRACTICES TO OFFER APPROPRIATELY COMPETITIVE SALARIES AND PRACTICE ENVIRONMENTS, INCLUDING REASONABLE CALL SCHEDULES. WE BELIEVE OUR ABILITY TO OFFER CORE NECESSARY PRIMARY CARE AND EMERGENCY SERVICES IS DEPENDENT ON SUBSIDIZATION OF PROVIDER PRACTICES DUE TO LOW VOLUMES IN THE ER RESULTING IN LOW REVENUES, BUT HIGH EXPENSES FROM HAVING TO STAFF A PROVIDER 24 HOURS PER DAY. |
| SCHEDULE H, PART I, LINE 7 | USED ADJUSTED COST TO CHARGE RATIOS FOR PATIENT CARE FROM THE MEDICARE COST REPORT, ADJUSTED FOR BED TAX AND COMMUNITY BENEFIT. BAD DEBT EXPENSE AND FINANCIAL ASSISTANCE ARE ALREADY EXCLUDED FROM THE MEDICARE COST REPORT. |
| SCHEDULE H, PART III, LINE 2 | THE ORGANIZATION'S PATIENT CARE COST TO CHARGE RATIO, AFTER ELIMINATING BAD DEBT EXPENSE, FINANCIAL ASSISTANCE, BED TAX, AND COMMUNITY BENEFIT EXPENSE, IS APPLIED TO GROSS BAD DEBT CHARGES, NOT INCLUDING IMPLICIT PRICE CONCESSIONS, TO ARRIVE AT THE COST OF BAD DEBT. DISCOUNTS AND IMPLICIT PRICE CONCESSIONS REDUCE REVENUE AND ARE NOT RECORDED AS BAD DEBT. PAYMENTS RECEIVED ON PREVIOUSLY WRITTEN OFF ACCOUNTS ARE RECORDED AS RECOVERIES OF IMPLICIT PRICE CONCESSIONS OR BAD DEBT, WHICH REDUCE IMPLICIT PRICE CONCESSIONS OR BAD DEBT EXPENSE. PATIENT OBLIGATIONS WHICH QUALIFY FOR FINANCIAL ASSISTANCE ARE NOT RECORDED AS IMPLICIT PRICE CONCESSIONS OR BAD DEBT EXPENSE. |
| SCHEDULE H, PART III, LINE 4 | THERE WERE NO BAD DEBT EXPENSES RECORDED AND THEREFORE NO RELATED FOOTNOTE AFTER ADOPTING THE NEW REVENUE RECOGNITION GUIDANCE IN FASB ASU 2014-09. MOST TRANSACTIONS WHICH PREVIOUSLY WOULD HAVE BEEN RECORDED AS BAD DEBT EXPENSE ARE CLASSIFIED AS IMPLICIT PRICE CONCESSIONS WHICH ARE RECORDED AS REDUCTIONS IN REVENUE VERSUS BAD DEBT EXPENSE. NOTE 11 TO THE CONSOLIDATED FINANCIAL STATEMENTS DISCUSSES IMPLICIT PRICE CONCESSIONS ON PAGES 21, 22, AND 23. |
| SCHEDULE H, PART III, LINE 8 | THERE IS A MEDICARE SHORTFALL SINCE CRITICAL ACCESS HOSPITALS ARE REIMBURSED 101 PERCENT OF COST FROM MEDICARE FOR MOST SERVICES, LESS THE 2% SEQUESTRATION ADJUSTMENT, AND SOME SERVICES ARE PAID BASED ON FEE SCHEDULES WHICH ARE OFTEN LESS THAN COST. MEDICARE COSTS ON PART III, LINE 6 ARE DIRECTLY FROM THE MEDICARE COST REPORT. MEDICARE REVENUE ON PART III, LINE 5 IS DIRECTLY FROM THE MEDICARE COST REPORT AND THE MEDICARE PROVIDER SUMMARY REPORT. |
| SCHEDULE H, PART III, LINE 9B | IF APPROVED FOR FINANCIAL ASSISTANCE UNDER THE PROVISIONS OF THE FINANCIAL ASSISTANCE POLICY (FAP), THE PATIENT WILL RECEIVE NOTIFICATIONS THAT INCLUDE: A. THE DISCOUNT OF GROSS CHARGES TO THE AGB. THEN FINANCIAL ASSISTANCE DISCOUNTS WILL BE APPLIED TO THE AGB IN ACCORDANCE WITH THE DISCOUNT OF AGB CHARGES SCHEDULE DESCRIBED IN THE "DISCOUNT" SECTION OF THE FAP. B. PROVIDING THE PATIENT WITH A BILLING STATEMENT THAT INDICATES THE AMOUNT THE PATIENT OWES, IF THEY ARE NOT ELIGIBLE FOR FREE CARE. C. REFUNDING ANY EXCESS PAYMENTS MADE BY THE INDIVIDUAL BEYOND THE AGB ON ELIGIBLE ACCOUNTS IF NECESSARY. D. TAKING ALL REASONABLY AVAILABLE MEASURES TO REVERSE EXTRAORDINARY COLLECTION ACTIONS THAT OCCURRED. |
| SCHEDULE H, PART VI, LINE 2 | WE SEND OUT PATIENT SATISFACTION SURVEYS TO OUR PATIENTS. |
| SCHEDULE H, PART VI, LINE 3 | RMC WILL MAKE ALL REASONABLE EFFORTS TO NOTIFY A PATIENT REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THIS POLICY BY: 1. ATTEMPTING TO DETERMINE WHETHER A PATIENT HAS THIRD-PARTY COVERAGE FOR ANY PART OF THE EMERGENCY OR MEDICALLY NECESSARY HEALTH CARE SERVICE PROVIDED. IF A PATIENT DOES NOT HAVE OR QUALIFY FOR THIRD-PARTY FUNDING, THE BUSINESS OFFICE STAFF WILL EXPLAIN THE FINANCIAL ASSISTANCE POLICY, PROVIDE AN APPLICATION FOR FINANCIAL ASSISTANCE AND PROVIDE ASSISTANCE WITH COMPLETING THE APPLICATION, IF DESIRED. 2. OFFERING THE PATIENT A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE AVAILABLE UNDER THIS POLICY AT THE TIME OF ADMISSION OR BEFORE DISCHARGE FROM RMC. 3. PROVIDING THE INFORMATION DURING THE NOTIFICATION PERIOD ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE ON AT LEAST THREE (3) BILLING STATEMENTS AND IN ALL OTHER WRITTEN COMMUNICATIONS IN REFERENCE TO FINANCIAL RECORDS TO THE PATIENT; 4. INFORMING PATIENTS DURING THE NOTIFICATION PERIOD ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE DURING ORAL COMMUNICATIONS REGARDING THE AMOUNT DUE FOR THE CARE THAT OCCURRED; 5. PROVIDING THE PATIENT WITH AT LEAST ONE WRITTEN NOTICE INFORMING THE PATIENT ABOUT THE EXTRAORDINARY COLLECTION ACTIONS THAT RMC MAY TAKE IF THE PATIENT DOES NOT SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE OR PAY THE AMOUNT DUE BY AT LEAST THIRTY DAYS FOLLOWING THE DATE OF THE NOTICE. THE NOTICE WILL NOT BE MAILED OR DELIVERED TO A PATIENT EARLIER THAN 30 DAYS PRIOR TO THE END OF THE NOTIFICATION PERIOD; AND 6. RMC WILL NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS AGAINST A PATIENT UNTIL SUCH TIME AS IT DETERMINES THE PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER THIS POLICY DURING THE 120 DAY NOTIFICATION PERIOD AND HAS PROVIDED THE PATIENT WITH THE NOTICE AS DESCRIBED ABOVE. |
| SCHEDULE H, PART VI, LINE 4 | WE PROVIDE SERVICE TO THE POPULATION IN EASTERN ROOSEVELT COUNTY, SOUTHERN SHERIDAN COUNTY, AND NORTHERN RICHLAND COUNTY. |
| SCHEDULE H, PART VI, LINE 5 | THE ADMINISTRATOR AND MARKETING DIRECTOR OF ROOSEVELT MEDICAL CENTER PARTICIPATE IN THE LOCAL CHAMBER OF COMMERCE. THE MARKETING DIRECTOR WRITES ARTICLES FOR THE LOCAL NEWSPAPER TO PROMOTE THE FACILITY AND DOES PUBLIC SERVICE ANNOUNCEMENTS THROUGH PRINTED MEDIA AND SOCIAL MEDIA (FACEBOOK). |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt |
|---|---|---|---|---|
| DANIELLE CHRISTENSEN | ||||
| RN | $180,761 | $8,460 | $189,221 | |
| ZOE FUGERE | ||||
| FNP | $163,237 | $8,461 | $171,998 | $300 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 1, PART I, LINE 6 | THE VOLUNTEERS ARE BOARD MEMBERS, MINISTERS AND GROUPS COMING IN TO SERVE DURING SOCIAL HOUR. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 IS REVIEWED BY THE ADMINISTRATOR, CFO, AND BOARD OF DIRECTORS BEFORE IT IS FILED. |
| FORM 990, PAGE 6, PART VI, LINE 12C | COMPLIANCE IS REVIEWED ANNUALLY. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE ADMINISTRATOR'S COMPENSATION IS APPROVED BY THE BOARD OF DIRECTORS WHICH IS USUALLY BASED ON THE AMOUNT/PERCENTAGE OF RAISE THE REST OF THE EMPLOYEES ARE GOING TO RECEIVE. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE CFO COMPILES INFORMATION FROM THE ANNUAL MHA SALARY SURVEY REGARDING AVERAGE WAGE BEING PAID FOR EACH JOB DESCRIPTION BASED ON PEER GROUP, CRITICAL ACCESS HOSPITALS, OR MHA REGION. THE CFO AND ADMINISTRATOR COMPARE AVERAGES BEING PAID TO THE CURRENT ROOSEVELT MEDICAL CENTER SALARY SCALE TO SEE IF ADJUSTMENTS NEED TO BE MADE TO KEEP EACH JOB COMPETITIVE WITHIN THE INDUSTRY. RECOMMENDATIONS FOR SALARY INCREASES ARE MADE TO THE BOARD OF DIRECTORS FOR APPROVAL OR DISAPPROVAL WHICH IS RECORDED IN THE BOARD MINUTES. |
| FORM 990, PAGE 6, PART VI, LINE 19 | DOCUMENTS RELATING TO ROOSEVELT MEDICAL CENTER ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | ADMIN PROF FEES 0 48,825 0 ADMIN PURCHASED SERVICES 0 27,873 0 CLINIC PROF FEES 317,575 0 0 DIETARY PURCHASED SERVICES 376,645 58,029 0 LAB PROF FEES 14,400 0 0 LAB PURCHASED SERVICES 46,035 0 0 MAINT PURCHASED SERVICES 1,925 462 7 MEDICAL /SURG. CONTRACT STAFF 121,707 0 0 MEDICAL & SURGICAL PURCH SVCS 8,398 0 0 MEDICAL RECORDS PURCH SVCS 0 417 0 OT PURCHASED SERVICES 11,221 0 0 PT PURCHASED SERVICES 194,400 0 0 AMBULANCE PURCHASED SERVICES 1,400 0 0 RADIOLOLGY PURCHASED SERVICES 8,231 0 0 SWING BED CONTRACT STAFF 657,781 0 0 SPEECH THERAPY PURCHASED SVCS 21,851 0 0 RADIOLOGY PROF FEES 322,430 0 0 PHARMACY PURCHASED SVCS 46,733 0 0 BUSINESS OFFICE PURCH SVCS 0 216 0 CLINIC PURCHASED SERVICES 920 0 0 ER PURCHASED SERVICES 30 0 0 ADMIN COLLECTION FEE 0 1,378 0 INFO SYSTEMS-PROF FEES 2,625 778 30 TOTAL 2,154,307 137,978 37 |
| FORM 990, PART XI, LINE 9 | PRIOR PERIOD ADJUSTMENT FOR INTEREST IN TRUST 1,465,324 ROUNDING -1 TOTAL 1,465,323 PRIOR PERIOD ADJUSTMENT FOR BENEFICIAL INTEREST IN PERPETUAL TRUST. SEE NOTE 2 AND NOTE 10 IN THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Business Name Line2DirectControllingEntityName/BusinessNameLine2Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROOSEVELT MEMORIAL HEALTHCARE FOUND | ||||||||||||
| PO BOX 419 | CULBERTSON | MT | 59218 | 810529284 | SUPPORT OR | MT | 501C3 | 7 | N/A | false | ||
| NE MT STAT AIR AMB COOP | ||||||||||||
| 81 AIRPORT ROAD | GLASGOW | MT | 59230 | 204748673 | AIR AMBUL | MT | 501C3 | 12B | false | NA | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| ROOSEVELT MEMORIAL HEALTHCARE FOUND | ||
| C | $63,315 | SUPPORT |
| ROOSEVELT MEMORIAL HEALTHCARE FOUND | ||
| O | $42,857 | PAYROLL |
| ROOSEVELT MEMORIAL HEALTHCARE FOUND | ||
| N | $3,402 | OCCUPANCY |