2024-05-07T14:00:41-05:00 2023-06-30 390758449 WIPFLI LLP 105 E PINE ST UPPER FLOOR MISSOULA MT 59802 990 2022-07-01 816016920 DANIELS MEMORIAL HOSPITAL DANI 4064872296 P O BOX 400 SCOBEY MT 59263 KODY BRINTON CEO 4064872296 2024-05-02 1 KODY BRINTON XXX-XX-XXXX 1 SAM BRUNSON CPA P01696998 4067281800 2024-05-02 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DANIELS MEMORIAL HEALTHCARE CENTER KODY BRINTON P O BOX 400 SCOBEY MT 59263 12643090 0 X WWW.DANIELSMEMORIALHEALTHCARE.ORG X 1956 MT WE ARE DEDICATED TO ENRICHING THE HEALTH OF THOSE WE SERVE AND TO STRENGTHENING OUR COMMUNITY FOR THE FUTURE. 8 8 96 15 0 0 160748 96248 11205769 11938261 541 5902 407700 602214 11774758 12642625 0 0 0 0 5284876 4963552 0 10500 10500 6202096 7514379 11486972 12488431 287786 154194 8481748 8965699 1598627 1929867 6883121 7035832 X DMHC WILL BE AN OASIS FOR HEALTH AND HEALING AND BE RECOGNIZED NATIONALLY AS A TOP 100 CAH. 0 0 5391769 0 10744611 PROFESSIONAL CARE PROVIDED BY A TEAM OF APPS TO INCLUDE PRIMARY CARE IN THE CLINIC SETTING, ACUTE, ER AND MENTAL HEALTH SERVICES. 1023470 0 1739397 CAH SERVICES INCLUDE ACUTE CARE, SKILLED SWING BED, ISB, AND ER WITH LEVEL 4 TRAUMA DESIGNATION. ANCILLARY SERVICES INCLUDE CT AND US IMAGING, LABS, PHYSICAL THERAPY, AND SPEECH THERAPY. 974022 0 0 HOUSEKEEPING, LAUNDRY, LINEN & PLANT SERVICES - PROVIDE FOR THE HOUSEKEEPING AND BUILDING MAINTENANCE OF THE FACILITY. 575735 0 56467 DIETARY SERVICES FOR ACUTE CARE PATIENTS. 575735 0 56467 7964996 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 9 0 96 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 8 8 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X THE ORGANIZATION 4064872296 P O BOX 400 SCOBEY MT 59263 X JACK PITTENGER CHAIR 2.00 X X 0 0 0 TANNER TROWER VICE CHAIR 2.00 X X 0 0 0 CARRIE WILSON VICE CHAIR (THRU 11/22) 2.00 X X 0 0 0 JEDDA BARRON SECRETARY 2.00 X X 0 0 0 JANITZIA NELSON TREASURER 2.00 X X 0 0 0 MIKE BJARKO DIRECTOR 2.00 X 0 0 0 CLIFF HAMES DIRECTOR 2.00 X 0 0 0 PAUL KANNING DIRECTOR 2.00 X 0 0 0 KYMBER CARNEY DIRECTOR 2.00 X 0 0 0 ALYCIA NATHE DIRECTOR (THRU 2/23) 2.00 X 0 0 0 CLAIRE COYNE DIRECTOR (THRU 2/23) 2.00 X 0 0 0 KODY BRINTON CEO 40.00 X 0 0 0 GREG CROWDER NP 40.00 X 189120 0 35622 SHERRY GAIRRETT NP 40.00 X 130741 0 29690 SHIRLEY RELLER PT 40.00 X 139779 0 35241 DEANNA FERESTAD NP 40.00 X 147539 0 37730 JESSICA WINGE-PETERSON DON 40.00 X 135191 0 15181 742370 0 153464 12 0 1 0 BILLINGS CLINIC PO BOX 30357 BILLINGS MT 59107 MANAGEMENT, CEO, ACCOUNTING, IMAGING REA 639686 PRN STAFFING 2501 CADDIE LANE BRENTWOOD CA 94513 NURSES, CNAS, HOUSEKEEPING 625138 SOLIANT 5550 PEACHTREE PARKWAY STE 500 PEACHTREE CORNERS GA 30092 RADIOLOGY/LAB TECH 313772 BADLANDS MEDICAL STAFFING BOX 133 UNDERWOOD ND 58576 NURSES AND CNAS 288657 MONTANA HEALTH NETWORK 519 PLEASANT ST MILES CITY MT 59301 NURSES, CNAS, HOUSEKEEPING 277922 7 36582 59666 96248 PROFESSIONAL CARE REVENUE 623000 10269201 10269201 CLINIC REVENUE 623000 1669060 1669060 11938261 6367 6367 465 -465 -465 -465 HOSPITAL DISTRICT TAX REVENUE 623000 158875 158875 340B REVENUE 623000 1484 1484 INCOME/LOSS FROM INSURANCE CAPTIV 623000 -38729 -38729 480584 480584 602214 12642625 12540475 0 5902 X 3981985 2646024 1335961 81043 69788 11255 609106 498371 110735 291418 253897 37521 22676 22676 49079 49079 10500 10500 3842731 1377623 2465108 31873 504 31369 47059 19794 27265 265930 226166 39764 68970 21408 47562 560 560 10886 10886 358640 358640 130957 3628 127329 CONTRACTUAL ALLOWANCES 1293468 1293468 MEDICAL SUPPLIES AND PH 519815 519815 OTHER SUPPLIES 285053 277047 8006 REPAIRS & MAINTENANCE 202523 179531 22992 384159 218732 165427 12488431 7964996 4512935 10500 3038012 3127290 358737 744308 1608208 1339463 96562 94933 271339 286399 106195 89791 7375687 5236901 2339046 2138786 663649 1144729 8481748 8965699 662503 945275 195757 251825 219395 488542 765197 1598627 1929867 X 6783121 6935832 100000 100000 6883121 7035832 8481748 8965699 154194 -1483 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13500 13500 4234236 3500778 733458 2923604 1691158 1232446 204347 44965 159382 2138786 COST REPORT SETTLEMENT RECEIVABLE 600654 RIGHT OF USE ASSET 233730 SUBSCRIBERS EQUITY IN INSURANCE CAPTIVE 214962 BED TAX RECEIVABLE 90223 RESIDENT CASH 4460 DEPOSIT 700 1144729 COST REPORT SETTLEMENT PAYABLE 397000 RIGHT OF USE OPERATING LEASE 268754 GUARANTEE OF PATIENT LOANS 94933 RESIDENT TRUST FUND 4510 765197 X 11259625 -1483 -1483 11261108 1381517 1381517 12642625 11106914 0 11106914 1381517 1381517 12488431 PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. FEDERAL AND STATE INCOME TAXES ARE PAID ON NONEXEMPT UNRELATED BUSINESS INCOME IN ACCORDANCE WITH THE CODE. CURRENT ACCOUNTING GUIDELINES REQUIRE AN ORGANIZATION TO DETERMINE WHETHER IT IS MORE-LIKELY-THAN-NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE HOSPITAL RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS. FEDERAL RETURNS FOR TAX YEARS 2019 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRACTUAL ALLOWANCES & DISCOUNTS 1,293,468. BAD DEBT EXPENSE 88,049. PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRACTUAL ALLOWANCES & DISCOUNTS 1,293,468. BAD DEBT EXPENSE 88,049. X X X X X 1 BANNACK GROUP LLC PO BOX 1823 BOZEMAN MT 59715 CAPITAL CAMPAIGN 0 0 10500 0 10500 MT PART I, LINE 2B, COLUMN (IV) THE HOSPITAL AND ITS SUPPORTING ORGANIZATION, DANIELS MEMORIAL HOSPITAL FOUNDATION, ARE CONDUCTING A CAPITAL CAMPAIGN IN WHICH THE FOUNDATION WILL COLLECT ALL CONTRIBUTIONS. THE HOSPITAL AND THE FOUNDATION ARE SPLITTING THE PROFESSIONAL FUNDRAISING FEES. THE HOSPITAL'S PORTION OF THE SHARED FEE WAS $10,500 FOR FY2023. 1 1 1 X 1 X 1 1 1 0 0 134789 134789 0.01080 2162647 2162647 0.17320 2297436 2297436 0.18400 82858 43735 39123 0.00310 164707 164707 0.01320 247565 43735 203830 0.01630 2545001 43735 2501266 0.20030 1 87721 5527260 5565868 -38608 X 1 1 1 1 DANIELS MEMORIAL HOSPITAL PO BOX 400 SCOBEY MT 59263 WWW.DANIELSMEMORIALHEALTHCARE.ORG X X X X RURAL HEALTH CLINIC DANIELS MEMORIAL HEALTHCARE CENTER 1 0 0 1 X X X X X X X X 21 1 0 1 1 X WWW.DANIELSMEMORIALHEALTHCARE.ORG X 1 22 1 WWW.DANIELSMEMORIALHEALTHCARE.ORG 0 1 X 100.000000000000 400.000000000000 0 1 X X 1 X WWW.DANIELSMEMORIALHEALTHCARE.ORG X WWW.DANIELSMEMORIALHEALTHCARE.ORG X WWW.DANIELSMEMORIALHEALTHCARE.ORG X X X X X 1 X 0 X X X X 1 0 1 DANIELS MEMORIAL HEALTHCARE CENTER PART V, SECTION B, LINE 5: FIVE KEY INFORMANT INTERVIEWS WERE CONDUCTED TO IDENTIFY IMPORTANT LOCAL HEALTHCARE ISSUES, HOW TO IMPROVE THE HEALTH OF THE COMMUNITY, AND GAPS IN HEALTH SERVICES. IN ADDITION, SURVEYS WERE PROVIDED TO 600 HOUSEHOLDS IN THE DMHC SERVICE AREA WITH 127 COMPLETED SURVEYS BEING RETURNED. DANIELS MEMORIAL HEALTHCARE CENTER PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED IN COOPERATION WITH THE MONTANA OFFICE OF RURAL HEALTH. DANIELS MEMORIAL HEALTHCARE CENTER PART V, SECTION B, LINE 11: THE NEW COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED THE FOLLOWING SIGNIFICANT NEEDS:GOAL 1: IMPROVE ACCESS TO HEALTHCARE SERVICES IN DANIELS COUNTY.STRATEGY 1.1: INCREASE ACCESS TO PRIMARY CARE SERVICES AT DANIELS MEMORIAL HEALTHCARE CENTER (DMHC). ACTIVITIES: SINCE LAST YEAR, WE HAVE BEEN ABLE TO STABILIZE OUR MEDICAL STAFF BY ADDING THREE NEW PROVIDERS, THUS IMPROVING ACCESS TO PRIMARY CARE SERVICES. CREATE EDUCATION AND OUTREACH PLAN TO RAISE AWARENESS OF SERVICES THAT ADVANCED PRACTICE PROVIDERS CAN PROVIDE LOCALLY AND HOW DMHC IS WORKING TO EXPAND DESIRED PRIMARY CARE SERVICES. WE CONTINUE TO WORK WITH BILLINGS CLINIC AND ITS SPECIALTY PROVIDERS TO EXPAND OUR TELEHEALTH/TELEMEDICINE SERVICES. OUR TEAM HAS BEEN WORKING DILIGENTLY WITH THE LOCAL SCHOOL DISTRICT TO INTRODUCE HEALTH PROFESSIONS TO HIGH SCHOOL STUDENTS, STARTING DURING THE SOPHOMORE AND JUNIOR YEAR OF HIGH SCHOOL. OUR CNA PROGRAM CONTINUES TO HAVE AT LEAST ONE TO THREE ENROLLEES EVERY YEAR. STRATEGY 1.2: EXPLORE OPPORTUNITIES TO ENHANCE ACCESS TO SPECIALTY CARE IN DANIELS COUNTY. ACTIVITIES: DETERMINE OPPORTUNITIES TO SUSTAIN SPECIALTY SERVICES VIA TELEMEDICINE AT DANIELS MEMORIAL HEALTHCARE CENTER; IMPROVE EDUCATION AND OUTREACH TO DMHC STAFF AND THE SERVICE AREA ABOUT THE SPECIALTY SERVICES THAT ARE AVAILABLE LOCALLY VIA TELEMEDICINE; EXPLORE OPPORTUNITIES TO EXPAND CURRENT SPECIALTY SERVICES AT DANIELS MEMORIAL HEALTHCARE CENTER (I.E., ECHOCARDIOGRAMS, EXPANDED ULTRASOUND, AND WOMEN'S HEALTH, ETC.). OVER THE LAST YEAR, WE HAVE WORKED WITH OUR PSYCHIATRIC NURSE PRACTITIONER, AND OUR VARIOUS REHABILITATION THERAPISTS TO OFFER TELEMEDICINE/TELEHEALTH VISITS. WE HAVE SEEN AN IMPACT IN OUR ABILITY TO SERVE PEOPLE AND ACCOMMODATE THEIR SCHEDULES THROUGH THIS TELEHEALTH OFFERING.STRATEGY 1.3: SUPPORT LOCAL TRANSPORTATION SERVICES THAT ASSIST COUNTY RESIDENTS IN ACCESSING HEALTHCARE SERVICES IN THE REGION. ACTIVITIES: CONTINUE PARTICIPATION AND SUPPORT OF THE DANIELS COUNTY PUBLIC TRANSPORTATION. CONTINUE TO FACILITATE TRANSPORTATION TO AND FROM MEDICAL APPOINTMENTS AT DMHC AND WITHIN THE REGION FOR PATIENTS WHO DO NOT HAVE ACCESS TO RELIABLE TRANSPORTATION. DANILES COUNTY TRANSPORTATION IS CONTINUOUSLY LOOKING FOR QUALIFIED, INTERESTED DRIVERS TO FURTHER PROVIDE TRANSPORTATION SERVICES TO THOSE IN OUR COMMUNITIES, INCLUDING BUT NOT LIMITED TO THOSE 60 YEARS OF AGE AND UP. WORKING WITH MONTANA DEPARTMENT OF TRANSPORTATION, OUR TRANSPORTATION PROGRAM WILL BE PURCHASING A NEW VAN THIS UPCOMING YEAR.STRATEGY 1.4: SUPPORT AND EXPAND SERVICES THAT ASSIST DANIELS COUNTY SENIORS TO AGE IN PLACE.ACTIVITIES: CONTINUE TO PROVIDE SERVICES THAT ASSIST SENIORS TO AGE IN PLACE (I.E., VISITING NURSE, ADULT DAYCARE, LIFELINE, WHIRLPOOL, ETC.); CONTINUE TO PROVIDE ACCESS TO HEALTHY MEALS THROUGH MEALS ON WHEELS PROGRAM FOR SENIORS IN DANIELS COUNTY. OUR STAFF MEMBERS ALSO VOLUNTEER WITH THE STEPPING UP PROGRAM, SPONSORED THROUGH THE COUNTY PUBLIC HEALTH DEPARTMENT, THAT PROVIDES FALL PREVENTION CLASSES TO MEMBERS OF OUR COMMUNITY.GOAL 2: ENHANCE DANIELS MEMORIAL HEALTHCARE CENTER'S SUPPORT OF AND OUTREACH FOR HEALTH AND WELLNESS IN DANIELS COUNTY.STRATEGY 2.1: SUPPORT COMMUNITY PROGRAMS AND EVENTS THAT ENCOURAGE HEALTHY BEHAVIORS AND LIFESTYLES.ACTIVITIES: THIS LAST YEAR, OUR COMMUNITY RELATIONS MANAGER SPEARHEADED OUR FIRST ANNUAL COMMUNITY HEALTH FAIR AT OUR FACILITY. THE EVENT WAS WELL ATTENDED. THIS EVENT ALLOWED VARIOUS HEALTH FOCUS ORGANIZATIONS TO PARTICIPATE. THE COMMUNITY WAS ABLE TO TOUR THE HOSPITAL, VISITING EACH BOOTH LEARNING ABOUT THE DIFFERENT HEALTH SERVICES OUR FACILITY OFFERS, AS WELL AS THE COMMUNITY OFFERS. THEY WERE EVEN ABLE TO HAVE OUR LOCAL FIRE DEPARTMENT AND EMS CREW HAVE AN AMBULANCE AND A FIRE RESPONSE VEHICLE SO COMMUNITY MEMBERS COULD VIEW AND LEARN MORE ABOUT THEIR FIRST RESPONSE PROGRAMS. WE CONTINUE TO SUPPORT COMMUNITY HEALTH AND WELLNESS PROGRAMS AND EVENTS THAT PROMOTE HEALTHY BEHAVIORS, ACTIVITIES, AND SHARE HEALTH EDUCATION (SPONSOR TOWER HILL WALK AND GOLF TOURNAMENT, DMHC PRESENCE VIA AN ANNUAL FAIR BOOTH AND PROVIDE SPORTS PHYSICALS AT LOCAL SCHOOLS). GOAL 3: IMPROVE ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES AT DANIELS MEMORIAL HEALTHCARE CENTER.STRATEGY 3.1: EXPLORE OPPORTUNITIES TO ADVANCE ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES.ACTIVITIES: EXPLORE EXPANDING THE UTILIZATION OF TELEHEALTH MENTAL HEALTH SERVICES (I.E., PSYCHIATRIC NURSE PRACTITIONER); REASSESS CURRENT COMMUNITY AND REGIONAL PARTNERS/RESOURCES THAT STRENGTHEN ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES.STRATEGY 3.2: CONTINUE SUPPORT OF CURRENT MENTAL AND BEHAVIORAL HEALTH EFFORTS IN DANIELS COUNTY.ACTIVITIES: DUE TO THE ORIGINATING MEMBERS IN THE COMMUNITY WHO SERVED ON THE DANIELS COUNTY MENTAL HEALTH ADVISORY COMMITTEE NO LONGER LIVING IN THE COUNTY, THIS LOCAL COMMITTEE CURRENTLY DOES NOT EXIST. THERE ARE PLANS TO REVITALIZE THIS COMMITTEE IN THE NEAR FUTURE.DMHC IS UNABLE TO ADDRESS THE FOLLOWING NEEDS AT THIS TIME: 1. 9.2% OF SURVEY RESPONDENTS INDICATED THEY HAD DIFFICULTY GETTING A PRESCRIPTION OR TAKING THEIR MEDICATION REGULARLY DUE TO COST IN THE LAST YEAR. IN PARTNERSHIP WITH SERVICE FAMILY PHARMACY, DANIELS MEMORIAL JOINED THE 340B PROGRAM AND ARE FINE TUNING THE DETAILS. THE 340B PROGRAM IS DESIGNED TO ASSIST IN MAKING PRESCRIPTIONS MORE AFFORDABLE FOR PATIENTS WHO ARE FINANCIALLY NEEDY. 2. 2.1% OF SURVEY RESPONDENTS WERE CONCERNED ABOUT NOT HAVING ENOUGH FOOD TO EAT IN THE LAST YEAR. DANIELS MEMORIAL HEALTHCARE CENTER PROVIDES MONETARY AND FOOD DONATIONS TO THE LOCAL FOOD PANTRY AS WELL AS REFERS COMMUNITY MEMBERS WHEN NECESSARY. PROVIDING A ROBUST STRATEGY TO ADDRESS FOOD INSECURITY IS CHALLENGING, HOWEVER DMHC IS IN PARTNERSHIP WITH THE CHAMBER OF COMMERCE AND DANIELS COUNTY PUBLIC HEALTH DEPARTMENT TO EXPLORE SOLUTIONS TO ADDRESS FOOD INSECURITY LOCALLY. DANIELS MEMORIAL HEALTHCARE CENTER PART V, SECTION B, LINE 24: PATIENT CARE WHICH IS NOT MEDICALLY NECESSARY INCLUDING ELECTIVE, COSMETIC, EXPERIMENTAL OR DEEMED TO BE GENERALLY NOT REIMBURSABLE BY TRADITIONAL INSURANCE CARRIERS AND GOVERNMENTAL PAYERS SHALL NOT BE CONSIDERED ELIGIBLE FOR CHARITY CARE. PART I, LINE 3C: THE ADMINISTRATOR CAN REVIEW ACCOUNTS ON A CASE-BY-CASE BASIS AND LOOK FOR INDICATION THAT THE FULL PAYMENT MAY CAUSE SOCIAL AND FINANCIAL HARDSHIP SO AS TO SIGNIFICANTLY HARM THE PATIENT OR THE FAMILY UNIT. PART I, LINE 7: A COST-TO-CHARGE RATIO WAS CALCULATED USING WORKSHEET 2. ALL AMOUNTS ON LINE 7 WERE CALCULATED USING THE WORKSHEETS PROVIDED IN THE SCHEDULE H INSTRUCTIONS. PART III, LINE 2: BAD DEBT EXPENSE IS THE THE BAD DEBT EXPENSE LESS BAD DEBT RECOVERY FROM THE INCOME STATEMENT. PART III, LINE 4: SEE NOTE 1 PATIENT ACCOUNTS RECEIVABLES AND CREDIT POLICY STARTING ON PAGE 14 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE COST TO CHARGE RATIO IS USED TO DETERMINE COMMUNITY BENEFIT. THIS IS DONE BY APPLYING THE RATIO TO THE TOTAL MEDICARE REVENUE. A SHORTFALL OR OVERAGE IN ANY GIVEN YEAR IS A RESULT OF THE TIMING OF PAYMENTS FROM MEDICARE ON AN INTERIM BASIS AND WHEN FINAL SETTLEMENT IS MADE. MANAGEMENT USES ESTIMATES TO CALCULATE SUCH SETTLEMENTS BUT ACTUAL RESULTS VARY FROM THOSE ESTIMATES. ADDITIONALLY, SHORTFALLS CAN RESULT FROM VARIOUS EXPENSES THAT ARE INCURRED BY THE FACILITY WHICH ARE CONSIDERED NON-REIMBURSABLE BY MEDICARE. SINCE PART OF THE COSTS ARE NOT REIMBURSED IT IS ONLY PRUDENT TO CONSIDER THIS SHORTFALL TO BE A BENEFIT TO THE COMMUNITY. ALSO MEDICARE RECIPIENTS ARE PART OF A CHARITABLE CLASS AND SO THE PROVISION OF MEDICAL CARE FURTHERS THIS CHARITABLE CLASS. PART III, LINE 9B: NOTIFICATION ABOUT THE DMHC CHARITY AVAILABILITY FORM, WHICH SHALL INCLUDE A CONTACT NUMBER, SHALL BE DISSEMINATED BY DMHC BY VARIOUS MEANS, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, THE PUBLICATION OF NOTICES IN PATIENT BILLS AND BY POSTING NOTICES IN EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS. INFORMATION SHALL ALSO BE INCLUDED ON THE FACILITY WEBSITES AND IN THE CONDITIONS OF ADMISSION FORM. SUCH INFORMATION SHALL BE PROVIDED IN THE PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVICED BY DMHC. REFERRAL OF PATIENTS FOR CHARITY MAY BE MADE BY ANY MEMBER OF THE DMHC STAFF OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL WORKERS, SOCIAL WORKERS, ETC. A REQUEST FOR CHARITY MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE FOR THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. PART VI, LINE 2: PRIMARILY DMHC WORKS CLOSELY WITH THE PUBLIC HEALTH DEPARTMENT AND LOCAL EMS, FIRE AND LAW ENFORCEMENT TO WORK TOGETHER TO ADDRESS ISSUES WITHIN THE COMMUNITY. PART VI, LINE 3: WE INFORM THE PUBLIC ABOUT PROGRAMS, I.E. MEDICARE/MEDICAID THROUGH ADVERTISEMENT IN PRINT AND RADIO, PAMPHLETS IN THE WAITING ROOM, AND SOCIAL SERVICE VISITS WITH PATIENTS. PART VI, LINE 4: WE ARE DESIGNATED A FRONTIER CAH. THE COUNTY HAS 1,690 PEOPLE. WE ARE FIVE HOURS AWAY FROM A TERTIARY HOSPITAL AND THREE HOURS AWAY FROM A SECONDARY HOSPITAL. PART VI, LINE 5: WE ARE GOVERNED BY A COMMUNITY BOARD REPRESENTING THE FULL SERVICES AREA. WE ALSO PARTICIPATE IN EASTERN MONTANA TELEMEDICINE AND ARE ABLE TO OFFER VISITS WITH MULTIPLE SPECIALTY PROVIDERS. X 0 0 0 0 0 0 0 0 0 GREG CROWDER NP 185895 0 3225 0 0 0 0 0 35622 0 224742 0 0 0 DEANNA FERESTAD NP 143814 0 3725 0 0 0 0 0 37730 0 185269 0 0 0 SHIRLEY RELLER PT 139554 0 225 0 0 0 0 0 35241 0 175020 0 0 0 SHERRY GAIRRETT NP 130591 0 150 0 0 0 0 0 29690 0 160431 0 0 0 JESSICA WINGE-PETERSON DON 134966 0 225 0 0 0 0 0 15181 0 150372 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL HAS A MANAGEMENT AGREEMENT WITH BILLINGS CLINIC. THEY PROVIDE MANAGEMENT, IT, AND ACCOUNTING SERVICES. THE ORGANIZATION'S CURRENT CEO, KODY BRINTON, IS AN EMPLOYEE OF BILLINGS CLINIC AND COMPENSATION FOR SERVICES PROVIDED TO THE HOSPITAL INCLUDE THE FOLLOWING: BASE SALARY - $123,061 EMPLOYER CONTRIBUTION TO MEDICAL AND DENTAL - $21,333 EMPLOYER CONTRIBUTION TO LIFE INSURANCE AND LONG-TERM DISABILITY - $481 FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OF THE CORPORATION SHALL BE 18 YEARS OF AGE AND COMPOSED OF THE TAXPAYERS OF DANIELS COUNTY AND/OR PERSONS WHO SHALL HAVE CONTRIBUTED TO OR PATRONIZED THE DANIELS MEMORIAL HOSPITAL ASSOCIATION BY THE TIME OF THE CORPORATION'S ANNUAL MEETING. THIS IS THE ONLY CLASS OF MEMBERSHIP. FORM 990, PART VI, SECTION A, LINE 7A NINE OF THE TEN DIRECTORS OF THE ORGANIZATION SHALL BE ELECTED BY THE MEMBERS OF THE CORPORATION AT THE ANNUAL MEETING. THE 10TH POSITION IS THE REPRESENTATIVE FROM THE HOSPITAL DISTRICT. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS AVAILABLE FOR REVIEW BY THE BOARD AFTER APPROVAL BY THE CEO. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE REVIEWED AND SIGNED BY ALL TRUSTEES AND THE CEO ANNUALLY. THE BOARD AND THE CEO MONITOR THE STATUS OF ALL TRUSTEES THROUGHOUT THE YEAR FOR CHANGES THAT COULD LEAD TO A NEW SITUATION REQUIRING DISCLOSURE. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF TRUSTEES REVIEWS AND MAKES DECISIONS ON THE COMPENSATION PACKAGE FOR THE CEO. THE CEO COMPENSATION IS PART OF THE MANAGEMENT CONTRACT PAID TO THE OUTSIDE MANAGEMENT COMPANY. ALL MANAGERS REPORT TO THE CEO AND THE CEO REVIEWS AND MAKES DECISIONS ON THE MANAGER'S COMPENSATION. BOARD OFFICERS ARE NOT COMPENSATED. THE CEO REVIEWS MHA WAGE SURVEY INFORMATION AS WELL AS INTERNAL EQUITY TO DETERMINE COMPENSATION OF KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, INCLUDING THE CONFLICT OF INTEREST STATEMENTS AND THE FINANCIAL STATEMENTS, ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 560. MANAGEMENT AND GENERAL EXPENSES 89,050. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 89,610. CONTRACTUAL SERVICES: PROGRAM SERVICE EXPENSES 1,377,063. MANAGEMENT AND GENERAL EXPENSES 2,376,058. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,753,121. FORM 990, PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. DANIELS MEMORIAL HOSPITAL FOUNDATION 105 5TH AVE SCOBEY MT 59263 363461891 COMMUNITY HEALTHCARE SUPPORT MT 501(C)(3) LINE 12D, III-O N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0