POWELL COUNTY MEMORIAL HOSPITAL ASSOCIATION: Form 990, tax year 2021
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- Organization
- POWELL COUNTY MEMORIAL HOSPITAL ASSOCIATION (EIN 81-0469886)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-03-29
- IRS object ID
- 202320889349300022
- Schema version
- 2021v4.2
- 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 D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-03-29T11:32:25-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 EAST FRONT STREET 301 | AddressLine1Txt |
| City | MISSOULA | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59802 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810469886 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL COUNTY MEMORIAL HOSPITAL ASSOC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | POWE | BusinessNameControlTxt |
| Phone | 4068462212 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 HOLLENBACK LANE | AddressLine1Txt |
| City | DEER LODGE | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59722 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TONY PFAFF | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 4068462212 | PhoneNum |
| Signature | 2023-03-27 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | TONY | PersonFirstNm |
| Person Last | PFAFF | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SAM BRUNSON CPA | PreparerPersonNm |
| PTIN | P01696998 | PTIN |
| Phone | 4067281800 | PhoneNum |
| Preparation | 2023-03-27 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | 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 | DEER LODGE MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TONY PFAFF | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 HOLLENBACK LANE | AddressLine1Txt |
| City | DEER LODGE | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $25,178,377 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | DLMED.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1991 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE PATIENT FOCUSED HEALTHCARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 162 | TotalEmployeeCnt |
| Total Volunteers | 7 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $5,435,157 | PYContributionsGrantsAmt |
| CY Contributions Grants | $563,144 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $22,705,815 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $22,985,309 | CYProgramServiceRevenueAmt |
| PY Investment Income | $323,612 | PYInvestmentIncomeAmt |
| CY Investment Income | $135,428 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$31,539 | PYOtherRevenueAmt |
| CY Other Revenue | $284,449 | CYOtherRevenueAmt |
| PY Total Revenue | $28,433,045 | PYTotalRevenueAmt |
| CY Total Revenue | $23,968,330 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,417,150 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $11,116,897 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,275,266 | PYOtherExpensesAmt |
| CY Other Expenses | $9,411,888 | CYOtherExpensesAmt |
| PY Total Expenses | $19,692,416 | PYTotalExpensesAmt |
| CY Total Expenses | $20,528,785 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $8,740,629 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,439,545 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $37,989,532 | TotalAssetsBOYAmt |
| Total Assets EOY | $41,519,337 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $16,853,574 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $20,905,265 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $21,135,958 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $20,614,072 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE PATIENT FOCUSED HEALTHCARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $17,611,634 | ExpenseAmt |
| Revenue | $23,268,894 | RevenueAmt |
| Desc | THE HOSPITAL PROVIDES DAILY PATIENT CARE SERVICES AND IS THE ONLY SOURCE OF THESE SERVICES IN THE AREA. THE HOSPITAL NOW ALSO HAS AN AMBULANCE SERVICE. | Desc |
| Total Program Service Expenses | $17,611,634 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | Yes (1) | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 38 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 162 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | 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 | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JENNIFER SPRING | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4068462212 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 HOLLENBACK LANE | AddressLine1Txt |
| City | DEER LODGE | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| JACK ANDERSON | ||||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| TERRY MOSIER | ||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| HOWARD NECKELS | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| COLTER CUMIN | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JIM DECKER | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| CARLEE HANSEN | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ED MCCARTHY | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| TONY PFAFF | ||||||||
| CEO | 40.00 | Yes (X) | $0 | $0 | $0 | |||
| JENNIFER SPRING | ||||||||
| CFO | 40.00 | Yes (X) | $142,832 | $0 | $4,807 | |||
| JUDITH WILSON | ||||||||
| MD | 40.00 | $237,180 | $0 | $13,312 | Yes (X) | |||
| SCOT MURRAY | ||||||||
| MD | 40.00 | $490,443 | $0 | $46,272 | Yes (X) | |||
| VAUGHN JOHNSON | ||||||||
| MD | 40.00 | $383,510 | $0 | $35,089 | Yes (X) | |||
| SUMERA QAMAR | ||||||||
| DO | 40.00 | $262,568 | $0 | $12,924 | Yes (X) | |||
| LORI DRUMM | ||||||||
| DO | 40.00 | $244,272 | $0 | $36,974 | Yes (X) | |||
| JAENA RICHARDS | ||||||||
| COO | 40.00 | $184,498 | $0 | $32,470 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,945,303 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $181,848 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 18 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CYPRESS HEALTHCARE LLC | |||||
| 791 EASTSIDE ROAD | DEER LODGE | MT | 59722 | MANAGEMENT, CEO AND REVENUE INTEGRITY SE | $555,774 |
| TRANSCENDENT ANES & PAIN SERVICE SCOTT | |||||
| 330 TRIPLE TREE RD | BOZEMAN | MT | 59715 | ANESTHESIA & PAIN MGMT. SERVICES | $545,994 |
| CHAD COLVIN DBA HIGH MTN CRITICAL CARE | |||||
| 926 W SHERASON DR | EAGLE | ID | 836167156 | EMERGENCY ROOM PHYSICIAN | $372,263 |
| THOMAS CUISINE MANAGEMENT | |||||
| 700 E FRANKLIN ROAD | MERIDIAN | ID | 83642 | CAFE/DIETARY MANAGEMENT | $291,839 |
| MONIDA SHARED IMAGING | |||||
| 1200 S RESERVE ST STE H | MISSOULA | MT | 59801 | MRI SERVICES | $210,004 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $52,268 | RelatedOrganizationsAmt |
| Government Grants | $478,662 | GovernmentGrantsAmt |
| All Other Contributions | $32,214 | AllOtherContributionsAmt |
| Total Contributions | $563,144 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621110 | $20,928,836 | $20,928,836 |
| UTILIZATION FEE REVENUE | 621110 | $1,560,018 | $1,560,018 |
| OTHER OPERATING REVENUE | 621110 | $496,455 | $496,455 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $22,985,309 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $143,684 | TotalRevenueColumnAmt |
| Exclusion | $143,684 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $26,645 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $25,781 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $864 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $864 | TotalRevenueColumnAmt |
| Exclusion | $864 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,175,940 | SecuritiesAmt |
| Other | $70 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,147,153 | SecuritiesAmt |
| Other | $37,113 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $28,787 | SecuritiesAmt |
| Other | -$37,043 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$8,256 | TotalRevenueColumnAmt |
| Exclusion | -$8,256 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | 340B REVENUE | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $283,585 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $283,585 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $283,585 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,968,330 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $23,268,894 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $136,292 | ExclusionAmt |
| 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 | $360,870 | TotalAmt |
| Program Services | $298,404 | ProgramServicesAmt |
| Management And General | $62,466 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,133,520 | TotalAmt |
| Program Services | $6,705,643 | ProgramServicesAmt |
| Management And General | $1,427,877 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $189,429 | TotalAmt |
| Program Services | $165,816 | ProgramServicesAmt |
| Management And General | $23,613 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,859,289 | TotalAmt |
| Program Services | $1,627,526 | ProgramServicesAmt |
| Management And General | $231,763 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $573,789 | TotalAmt |
| Program Services | $502,265 | ProgramServicesAmt |
| Management And General | $71,524 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,944 | TotalAmt |
| Management And General | $17,944 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,012,869 | TotalAmt |
| Program Services | $2,892,111 | ProgramServicesAmt |
| Management And General | $120,758 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,490 | TotalAmt |
| Management And General | $86,490 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $202,374 | TotalAmt |
| Program Services | $122,386 | ProgramServicesAmt |
| Management And General | $79,988 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $287,420 | TotalAmt |
| Program Services | $38,027 | ProgramServicesAmt |
| Management And General | $249,393 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $247,613 | TotalAmt |
| Program Services | $247,613 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,631 | TotalAmt |
| Program Services | $43,739 | ProgramServicesAmt |
| Management And General | $8,892 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $484,344 | TotalAmt |
| Program Services | $461,504 | ProgramServicesAmt |
| Management And General | $22,840 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,006,623 | TotalAmt |
| Program Services | $966,358 | ProgramServicesAmt |
| Management And General | $40,265 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $220,605 | TotalAmt |
| Program Services | $213,599 | ProgramServicesAmt |
| Management And General | $7,006 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $1,991,435 | $1,779,509 | $211,926 |
| OTHER OPERATING SUPPLIE | $741,887 | $741,745 | $142 |
| OTHER OPERATING EXPENSE | $393,477 | $380,842 | $12,635 |
| REPAIRS & MAINTENANCE | $210,881 | $204,344 | $6,537 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $455,295 | TotalAmt |
| Program Services | $220,203 | ProgramServicesAmt |
| Management And General | $235,092 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,528,785 | TotalAmt |
| Program Services | $17,611,634 | ProgramServicesAmt |
| Management And General | $2,917,151 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $709,894 | BOYAmt |
| EOY | $753,136 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,198,765 | BOYAmt |
| EOY | $7,859,920 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,426,249 | BOYAmt |
| EOY | $3,070,658 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,081 | BOYAmt |
| EOY | $44,507 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $524,966 | BOYAmt |
| EOY | $606,060 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $178,851 | BOYAmt |
| EOY | $296,089 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $29,739,440 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $8,528,588 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,681,928 | BOYAmt |
| EOY | $21,210,852 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,872,134 | BOYAmt |
| EOY | $5,251,950 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,698 | BOYAmt |
| EOY | $35,698 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,310,966 | BOYAmt |
| EOY | $2,390,467 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,989,532 | BOYAmt |
| EOY | $41,519,337 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,489,901 | BOYAmt |
| EOY | $3,143,577 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $242,574 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,465,000 | BOYAmt |
| EOY | $12,835,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $898,673 | BOYAmt |
| EOY | $4,684,114 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,853,574 | BOYAmt |
| EOY | $20,905,265 | 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 | $21,135,958 | BOYAmt |
| EOY | $20,614,072 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,135,958 | BOYAmt |
| EOY | $20,614,072 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,989,532 | BOYAmt |
| EOY | $41,519,337 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $3,439,545 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$898,709 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | -$3,062,722 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | 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 D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $695,642 | OtherCostOrOtherBasisAmt |
| Book Value | $695,642 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,686,490 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,364,877 | DepreciationAmt |
| Book Value | $11,321,613 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,309,853 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,163,711 | DepreciationAmt |
| Book Value | $2,146,142 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,047,455 | OtherCostOrOtherBasisAmt |
| Book Value | $7,047,455 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $21,210,852 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| BOND FUNDS | $2,011,983 |
| INVESTMENT IN YELLOWSTONE INSURANCE EXCHANGES RRG | $188,330 |
| INVESTMENT IN WORKERS COMPENSATION | $115,154 |
| INVESTMENT IN MONIDA SHARED IMAGING | $75,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,390,467 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $22,990,212 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$898,709 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $25,781 | OtherRevenueAmt |
| Revenue Not Reported | -$872,928 | RevenueNotReportedAmt |
| Revenue Subtotal | $23,863,140 | RevenueSubtotalAmt |
| Other Revenues Not Included | $105,190 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $105,190 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $23,968,330 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $20,449,376 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $25,781 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $25,781 | ExpensesNotReportedAmt |
| Expenses Subtotal | $20,423,595 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $105,190 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $105,190 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $20,528,785 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE HOSPITAL IS A TAX-EXEMPT 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 TAXES ON RELATED INCOME PURSUANT TO SIMILAR STATE OF MONTANA TAX LAWS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | DIRECT RENT EXPENSE DEDUCTED FROM GROSS RENTS FOR 990 REVENUE 25,781. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | 340B PHARMACEUTICAL EXPENSES NETTED W/ REVENUE ON FINANCIAL STATEMENTS 105,190. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | DIRECT RENT EXPENSE DEDUCTED FROM GROSS RENTS FOR 990 REVENUE 25,781. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | 340B PHARMACEUTICAL EXPENSES NETTED W/ REVENUE ON FINANCIAL STATEMENTS 105,190. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 250.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $129,230 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $129,230 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00630 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,712,141 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,992,352 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,841,371 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,992,352 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $129,230 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00630 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $115,234 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,944 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $104,290 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00510 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $34,787 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $34,787 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,680 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,680 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $154,701 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,944 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $143,757 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00700 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,996,072 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,003,296 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $272,987 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01330 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,594 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,594 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,364 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,364 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,771 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,771 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,729 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,729 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $89,952 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $7,760,376 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,746,600 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $13,776 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 CYPRESS HEALTHCARE LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | MANAGEMENT SERVICES | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.00000 | OrgProfitOrOwnershipPct |
| Ofcr Etc Profit Or Ownership | 1.00000 | OfcrEtcProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.00000 | PhysiciansProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | POWELL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 HOLLENBACK LANE | AddressLine1Txt |
| City | DEER LODGE | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.DLMED.ORG | WebsiteAddressTxt |
| State License | 12992 | StateLicenseNum |
| 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 | POWELL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | 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 |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW. DLMED.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.DLMED.ORG | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 250.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.DLMED.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.DLMED.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.DLMED.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 |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | 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 (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| POWELL COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: A STEERING COMMITTEE WAS CONVENED TO ASSIST DEER LODGE MEDICAL CENTER IN CONDUCTING CHSD. A DIVERSE GROUP OF COMMUNITY MEMBERS REPRESENTING VARIOUS ORGANIZATIONS AND POPULATIONS WITHIN THE COMMUNITY (EX. PUBLIC HEALTH, ELDERLY, UNINSURED) CAME TOGETHER IN OCTOBER 2021. FOR A LIST OF ALL STEERING COMMITTEE MEMBERS AND THEIR AFFILIATIONS, SEE APPENDIX A OF THE CHNA. THE STEERING COMMITTEE MET TWICE DURING THE CHSD PROCESS; FIRST TO DISCUSS HEALTH CONCERNS IN THE COMMUNITY AND OFFER THEIR PERSPECTIVE IN DESIGNING THE SURVEY INSTRUMENT, AND AGAIN TO REVIEW RESULTS OF THE CHNA AND TO ASSIST IN THE PRIORITIZATION OF HEALTH NEEDS. |
| POWELL COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6B: THE MONTANA STATE UNIVERSITY OFFICE OF RURAL HEALTH, AREA HEALTH EDUCATION CENTER, FACILITATED THE PREPARATION OF OUR COMMUNITY HEALTH NEEDS ASSESSMENT. |
| POWELL COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: CHNA SIGNIFICANT NEED #1: ENHANCE DEER LODGE MEDICAL CENTER'S HEALTH AND WELLNESS OUTREACH IN POWELL COUNTY.STRATEGY #1: EXPAND AND ENHANCE HEALTH AND WELLNESS PROGRAMS AND RESOURCES AT DEER LODGE MEDICAL CENTER.ACTIVITIES: EXPLORE OPPORTUNITIES TO EXPAND PLANETREE MINDFULNESS AND WELLNESS PROGRAMS THROUGH DLMC TO THE COMMUNITY; SUSTAIN THE NUTRITIONAL OUTREACH CAMPAIGN (SUCH AS MONTHLY HEALTHY RECIPES TO BE FEATURED IN CAF AND SHARED ON THE DLMC FACEBOOK PAGE) THAT PROMOTE PREVENTION AND HEALTHY DIETS; CONTINUE TO PROVIDE HEALTH EDUCATION OPPORTUNITIES THAT PROMOTE HEALTH AND WELLNESS (I.E., PRE-DIABETES SUPPORT GROUP, TRIM THE TOWN, WOMEN'S NIGHT OUT, STOP THE BLEED, ANNUAL HEALTH FAIR, ETC.); SUSTAIN THE PROGRAM THAT FITS CHILD CAR SEATS FOR LOCAL FAMILIES. STRATEGY #2: CONTINUE TO SUPPORT AND SPONSOR ACTIVITIES AND PROGRAMS THAT PROMOTE PHYSICAL ACTIVITY IN POWELL COUNTY.ACTIVITIES: DLMC WILL CONTINUE TO PROVIDE STAFF TO PARTICIPATE ON THE LOCAL TRAIL COMMITTEE AND EXPLORE OPPORTUNITIES TO RAISE AWARENESS OF LOCAL TRAILS AND PROMOTE TRAIL UTILIZATION (I.E., BIKE WALK MONTANA, WALKING RX TRAILS); SPONSOR LOCAL ADULT AND YOUTH RECREATIONAL LEAGUES; CONTINUE TO HOST COMMUNITY EVENTS THAT PROMOTE PHYSICAL ACTIVITY (I.E., GOLF TOURNAMENT, ANNUAL HEALTH WALK, ETC.); CONTINUE TO PROVIDE YOUTH SPORTS PHYSICALS, CONCUSSION SCREENING AND HELMET PROMOTION PROGRAM.CHNA SIGNIFICANT NEED #2: ACCESS TO HEALTHCARE SERVICES IN POWELL COUNTY.STRATEGY #1: IMPROVE AND SUSTAIN ACCESS TO HEALTHCARE SERVICES IN POWELL COUNTY.ACTIVITIES: CONTINUE TO IMPLEMENT CARDIAC PULMONARY REHABILITATION PHASE TWO (I.E., MONITOR/TRACK PHYSICAL ACTIVITY AND NUTRITION AMONG IDENTIFIED ELIGIBLE PATIENTS THROUGH QUALIFYING EVENTS). CONTINUE TO REFER PROGRAM "GRADUATES" TO PHASE THREE (I.E., COMPLIMENTARY PASSES TO FITNESS CENTER TO REDUCE BARRIERS TO CONTINUING PHYSICAL ACTIVITY); DEVELOP AND IMPLEMENT A COMMUNITY INTEGRATED HEALTH PROFESSIONAL (CIH) PROGRAM DEPLOYING PARAMEDICS TO PROVIDE ADDITIONAL SERVICES TO HELP COMMUNITY MEMBERS ACCESS CARE IN NON-EMERGENCY SITUATIONS (I.E., POST DISCHARGE FOLLOW-UP, PREVENTIVE CARE, CHRONIC DISEASE MANAGEMENT, REFERRALS TO COMMUNITY HEALTH SERVICES, MEDICATION MANAGEMENT AND SET UP, HOME SAFETY CHECKS, ETC.); DLMC WILL CONTINUE TO WORK WITH AREA PARTNERS TO SUSTAIN AMBULANCE SERVICES IN POWELL COUNTY. DLMC WILL ALSO SUSTAIN THE PEDIATRIC PREPAREDNESS GOLD STANDARD AND CONTINUE PROVIDING REGULAR TRAINING AND SUPPLIES TO THE LOCAL QUICK RESPONSE UNITS; CONTINUE TO SUPPORT ANNUAL LOW-COST LABS AND MONTHLY FOOT CARE CLINICS; CONTINUE SPONSORING MONTHLY HEALTH OUTREACH OPPORTUNITIES THROUGH THE LOCAL SENIOR CENTER (I.E., BLOOD PRESSURE CHECKS, MEDICATION MANAGEMENT, ETC.); EXPLORE THE FEASIBILITY OF RECRUITING ADDITIONAL PRIMARY CARE PROVIDERS LOCALLY; SUSTAIN PATIENT NAVIGATOR SERVICES LINKING PATIENTS TO COMMUNITY RESOURCES. FACILITATE PRESUMPTIVE ELIGIBILITY STATUS FOR PROGRAMS LIKE MEDICAID, MEDICARE, 340B PROGRAM, ETC. IMPLEMENT METHODOLOGY AND PROTOCOLS TO SHARE FINANCIAL ASSISTANCE RESOURCES WITH THE COMMUNITY (I.E., CLINIC, EMERGENCY ROOM, DLMC WEBSITE, ETC.); CONTINUE TO IMPLEMENT TELEHEALTH CRISIS PROTOCOLS WHEN PATIENTS IN CRISIS PRESENT IN THE EMERGENCY ROOM; CONTINUE TO OFFER TELEPSYCHIATRY SERVICES LOCALLY, INCLUDING MEDICATION ASSISTANCE; CONTINUE TO OFFER TELE-ONCOLOGY SERVICES THROUGH DLMC. DLMC WILL HOST AN OPEN HOUSE IN JUNE 2022 TO RAISE THE COMMUNITY'S AWARENESS OF THIS SERVICE.STRATEGY #2: IMPROVE KNOWLEDGE OF SERVICES AVAILABLE THROUGH DEER LODGE MEDICAL CENTER AND IN THE COMMUNITY.ACTIVITIES: CONTINUE TO CONVENE A DLMC WORKGROUP/ADMINISTRATIVE TEAM TO DISCUSS CURRENT OUTREACH EFFORTS, GAPS AND NEW OPPORTUNITIES (I.E., ADA COMPLIANCE, WEBSITE DEVELOPMENT, ETC.). CONTINUE TO SUPPORT THE COMMUNITY RESOURCES PAGE ON DLMC WEBSITE THAT WAS BUILT DURING THE LAST IMPLEMENTATION PERIOD; CONTINUE TO SHARE OUTREACH FLYERS, HANDOUTS, AND MESSAGES ON THE SCREEN IN LOBBY DETAILING LOCAL RESOURCES (I.E., SENIOR SERVICES, MENTAL HEALTH RESOURCES, NEW SERVICES, FINANCIAL ASSISTANCE, ETC.); REVISIT OUTREACH/INFORMATION MATERIALS ABOUT DLMC PROVIDERS AND SERVICES (I.E., GRIEF SUPPORT GROUPS, TELEHEALTH SERVICES, ETC.) THAT WERE CREATED DURING THE LAST IMPLEMENTATION PERIOD; CONTINUE TO PROVIDE EDUCATION THROUGH PRESENTATIONS TO LOCAL ORGANIZATIONS (I.E., ROTARY CLUB, PUBLIC HEALTH, LOCAL SCHOOLS, ETC.).DLMC IS UNABLE TO ADDRESS THE FOLLOWING NEEDS AT THIS TIME:1. 59.2% OF SURVEY RESPONDENTS NOTED "ALCOHOL/SUBSTANCE ABUSE" AS A TOP HEALTH CONCERN FOR THE COMMUNITY. DEER LODGE MEDICAL CENTER (DLMC) PRIMARY CARE PROVIDERS COUNCIL PATIENTS ON SUBSTANCE ABUSE AS NEEDED BASED ON THE INDIVIDUAL AS PART OF THE GENERAL CARE. AS NECESSARY, PATIENTS ARE REFERRED TO SPECIALISTS FOR FURTHER HELP/TREATMENT.2. SURVEY RESPONDENTS INDICATED TO WHAT DEGREE THEIR LIFE HAS BEEN NEGATIVELY AFFECTED BY THEIR OWN OR SOMEONE ELSE'S SUBSTANCE ABUSE ISSUES, INCLUDING ALCOHOL, PRESCRIPTION, OR OTHER DRUGS: "A LITTLE (16.3%), "SOMEWHAT" (22.0%), AND "A GREAT DEAL" (16.3%). DEER LODGE MEDICAL CENTER (DLMC) PRIMARY CARE PROVIDERS COUNCIL PATIENTS ON SUBSTANCE ABUSE AS NEEDED BASED ON THE INDIVIDUAL AS PART OF THE GENERAL CARE. AS NECESSARY, PATIENTS ARE REFERRED TO SPECIALISTS FOR FURTHER HELP/TREATMENT.3. FOCUS GROUP PARTICIPANTS WERE INTERESTED IN AN IMPROVEMENT TO SENIOR SERVICES LOCALLY SPECIFICALLY ADDITIONAL SENIOR HOUSING OPTIONS AND HOME HEALTH SERVICES. COMMUNITY HOUSING IS BEYOND THE SCOPE OF THE SERVICES BEING FOCUSED ON BY DLMC. COMMUNITY GROUPS (I.E., COUNCIL ON AGING, RENAISSANCE, ETC.) ARE ACTIVE MEMBERS ON DLMC'S PATIENT FAMILY ADVISORY COUNCIL. DLMC SUPPORTS THESE SERVICES AND INITIATIVES AS POSSIBLE.4. 44.8% OF SURVEY RESPONDENTS INDICATED DESIRE IN "URGENT CARE" SERVICES AVAILABLE LOCALLY. ALL SERVICES PROVIDED THROUGH AN URGENT CARE MODEL ARE AVAILABLE THROUGH THE EXISTING DLMC CLINIC. THE RESOURCE AND STAFFING OF AN URGENT CARE WERE NOT IDENTIFIED AS A PRIORITY AT THIS TIME. BASED ON VOLUMES, WALK IN PATIENTS ARE TYPICALLY ABLE TO BE SEEN SAME DAY THROUGH THE DLMC CLINIC. |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | PCMH USED COST-TO-CHARGE RATIOS FROM ITS MOST RECENT MEDICARE COST REPORT TO DETERMINE THE COST OF FINANCIAL ASSISTANCE, MEDICAID, PROVIDING REDUCED COST SPORTS PHYSICALS, AND PROVIDING REDUCED COST LABS. COST ACCOUNTING, WHICH INCLUDED ALL SEGMENTS (INPATIENT, OUTPATIENT, ER, ET AL) WAS USED TO DETERMINE ALL OTHER AMOUNTS REPORTED IN THE TABLE.BAD DEBT EXPENSE WAS NOT A FACTOR IN CALCULATING THE PERCENTAGES FOR COLUMN F. |
| FORM 990, SCH H, PART I LINE C: | WE ONLY OFFER A 100% WRITE OFF AT 250% OF FPG. NO OTHER DISCOUNTS ARE GIVEN UNDER OUR FAP. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | COMMUNITY SUPPORT: PCHS CFO SERVED AS THE TREASURER FOR THE LOCAL BOOSTER CLUB THAT RAISES MONEY TO PURCHASE EQUIPMENT AND OTHER SUPPLIES FOR THE COMMUNITY'S HIGH SCHOOL ATHLETES. EMPLOYEES ALSO VOLUNTEERED TO WORK AT THE BOOSTER CLUB'S CONCESSION STAND.WORKFORCE DEVELOPMENT: PROVIDED HANDS-ON TRAINING, MEALS, AND LODGING FOR TWO COLLEGE INTERNS FOCUSING ON PROCESS IMPROVEMENT IN HEALTHCARE UTILIZING LEAN RAPID IMPROVEMENT METHODOLOGIES. PAID FOR A SUBSCRIPTION TO A RECRUITING SERVICE TO HELP RECRUIT MEDICAL PROFESSIONALS TO A HPSA. |
| PART III, LINE 2: | TREND ANALYSIS OF SELF-PAY ACCOUNT COLLECTIONS IS USED TO CREATE AN INITIAL ESTIMATE OF THE PROVISION FOR BAD DEBT ON SELF-PAY ACCOUNTS RECEIVABLE AT FISCAL YEAR-END. THE ESTIMATE IS THEN REDUCED FOR IMPLICIT PRICE CONCESSIONS. THE INCREASE OR DECREASE IN THE PROVISION IS ADJUSTED TO BAD DEBT EXPENSE. SUBSEQUENT COLLECTIONS RECEIVED ON ACCOUNTS PREVIOUSLY WRITTEN OFF REDUCE THE CURRENT BAD DEBT EXPENSE. |
| PART III, LINE 3: | NONE OF THE ABOVE BAD DEBT IS INCLUDED AS COMMUNITY BENEFIT. |
| PART III, LINE 4: | SEE PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | BY CONTINUING TO TREAT PATIENTS ELIGIBLE FOR MEDICARE, THE HOSPITAL ALLEVIATES THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES. COST ACCOUNTING (VIA THE MEDICARE COST REPORT) WAS USED TO DETERMINE THE ALLOWABLE MEDICARE COSTS. |
| PART III, LINE 9B: | PER OUR POLICY DLMC (PCMH) WILL NOT ENGAGE IN ECAS, EITHER DIRECTLY OR BY ANY DEBT COLLECTION AGENCY OR OTHER PARTY TO WHICH DLMC HAS REFERRED THE PATIENT'S DEBT, BEFORE REASONABLE EFFORTS ARE MADE TO DETERMINE WHETHER A RESPONSIBLE INDIVIDUAL(S) IS ELIGIBLE FOR ASSISTANCE UNDER THE FAP. |
| PART VI, LINE 2: | PCMH CONTINUES TO WORK THE LOCAL SCHOOLS, THE POWELL COUNTY PUBLIC HEALTH DEPARTMENT, POWELL COUNTY LOCAL EMERGENCY PREPAREDNESS COMMITTEE, MAJOR EMPLOYERS (SUN MOUNTAIN LUMBER, MONTANA STATE PRISON), LOCAL NURSING HOMES, POWELL COUNTY SENIOR CITIZEN CENTER, AND POWELL COUNTY COUNCIL ON AGING TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY WE SERVE. WE STRONGLY ENCOURAGE EMPLOYEES TO VOLUNTEER, ON PCMH TIME, FOR ORGANIZATIONS THAT STRIVE TO IMPROVE THE WELL-BEING OF OUR COMMUNITY MEMBERS. |
| PART VI, LINE 3: | PCMH STRIVES TO MEET WITH EVERY SELF-PAY PATIENT TO DETERMINE THEIR ABILITY TO PAY, AND OFFER FINANCIAL ASSISTANCE, MEDICAID PRESUMPTIVE ELIGIBILITY SCREENING, OR MONTHLY PAYMENT PLANS AS NEEDED. BEFORE TURNING AN ACCOUNT OVER TO 3RD PARTY COLLECTORS, WE PERFORM A REVIEW TO SEE IF THEY MEET THE PRESUMPTIVE ELIGIBILITY CRITERIA OF OUR FINANCIAL ASSISTANCE POLICY. SIGNS ARE POSTED THROUGHOUT THE FACILITY, ESPECIALLY AT PATIENT INTAKE AREAS, THAT NOTIFY PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. NOTICES ARE ALSO INCLUDED WITH BILLING STATEMENTS. WITH OUR RECENT REMODELING PROJECT, WE MADE SURE TO INCORPORATE A SEPARATE OFFICE THAT IS EASILY ACCESSIBLE FOR PATIENTS TO DISCUSS THEIR ACCOUNTS IN PRIVATE WITH OUR PATIENT ACCESS MANAGER. |
| PART VI, LINE 4: | PCMH SERVES THE COUNTIES OF POWELL, GRANITE, DEER LODGE, AND SILVER BOW, AND ALSO PROVIDES SERVICES TO INMATES AT THE MONTANA STATE PRISON. |
| PART VI, LINE 5: | AS THE POWELL COUNTY COMMUNITY WAS IN THE THROWS OF THE COVID-19 PANDEMIC FOR MOST OF THE FISCAL YEAR, WE HAD TO SCALE BACK OUR USUAL VOLUNTEER ACTIVITY AND OUTREACH SERVICES. THE GOVERNING BOARD OF PCMH CONSISTS OF RESIDENTS OF THE HOSPITAL'S PRIMARY SERVICE AREA. EMPLOYEES NOR INDEPENDENT CONTRACTORS (OTHER THAN DISCLOSED ON THIS FORM) OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF, ARE ALLOWED TO BE BOARD MEMBERS.PCMH EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PROVIDERS IN THE COMMUNITY. WE'VE ALSO CONTRACTED WITH SEVERAL VISITING SPECIALISTS TO OFFER SERVICES NOT OTHERWISE AVAILABLE IN OUR COMMUNITY (CARDIOLOGY, PAIN MANAGEMENT, UROLOGY, PODIATRY, TELEPSYCHIATRY).PCMH CONTINUALLY REINVESTS SURPLUS FUNDS BY UPDATING OUR FACILITIES AND EQUIPMENT AND EMPLOYING ADDITIONAL STAFF TO EXPAND THE SERVICES OFFERED TO THE COMMUNITY OR IMPROVE CURRENTLY OFFERED SERVICES. THE HOSPITAL CONTINUES TO OPERATE POWELL EMERGENCY MEDICAL SERVICE, WHICH BOUGHT OUT THE FLAILING LOCAL VOLUNTEER AMBULANCE COMPANY IN 2020, TO ENSURE THAT THE COMMUNITY WOULD CONTINUE TO HAVE AMBULANCE SERVICES. ALTHOUGH PEMS RECEIVES A LARGE AMOUNT OF LEVY MONEY TO OPERATE THE SERVICE, IT REALIZED A NET LOSS FOR FISCAL YEAR 2022. SURPLUS FUNDS ARE ALSO USED TO OFFER PROGRAMS AT FREE OR REDUCED CHARGES TO THE COMMUNITY, SUCH AS THE FOLLOWING:- FREE FOOT CARE CLINIC FOR THE AGING, DISABLED, AND DIABETIC COMMUNITY - FREE BASELINE CONCUSSION TESTING FOR LOCAL STUDENT ATHLETES- SCHOLARSHIPS TO HIGH SCHOOL STUDENTS PURSUING DEGREES IN HEALTH CARE- OFFERING LOW COST LAB WORK TWO DAYS A YEAR- MAINTAIN A COMMUNITY PLAYGROUND THAT PROVIDES A SAFE AREA FOR THE LOCAL YOUTH TO ENJOY HEALTHY OUTDOOR PLAY. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SCOT MURRAY | ||||||||||||||
| MD | $490,443 | $0 | $0 | $0 | $0 | $0 | $8,683 | $0 | $37,589 | $0 | $536,715 | $0 | $0 | $0 |
| VAUGHN JOHNSON | ||||||||||||||
| MD | $383,510 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $35,089 | $0 | $418,599 | $0 | $0 | $0 |
| LORI DRUMM | ||||||||||||||
| DO | $244,272 | $0 | $0 | $0 | $0 | $0 | $8,722 | $0 | $28,252 | $0 | $281,246 | $0 | $0 | $0 |
| SUMERA QAMAR | ||||||||||||||
| DO | $262,568 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $12,924 | $0 | $275,492 | $0 | $0 | $0 |
| JUDITH WILSON | ||||||||||||||
| MD | $237,180 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $13,312 | $0 | $250,492 | $0 | $0 | $0 |
| JAENA RICHARDS | ||||||||||||||
| COO | $184,498 | $0 | $0 | $0 | $0 | $0 | $6,545 | $0 | $25,925 | $0 | $216,968 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MONTANA FACILITY FINANCE AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 364615115 | BondIssuerEIN |
| CUSIP | 612043GQ6 | CUSIPNum |
| Bond Issued | 2010-08-01 | BondIssuedDt |
| Issue Price | $15,000,000 | IssuePriceAmt |
| Purpose | TO FINANCE THE CONSTRUCTION AND EQUIPPING OF A NEW HEALTH CARE FACILITY | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $2,165,000 | RetiredAmt |
| Total Proceeds | $15,000,000 | TotalProceedsAmt |
| In Reserve Fund | $1,184,142 | InReserveFundAmt |
| Working Capital Expenditures | $13,557,042 | WorkingCapitalExpendituresAmt |
| Unspent | $258,697 | UnspentAmt |
| Substantial Completion | 2011 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | 0 | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| JACK ANDERSON | |||
| MR. ANDERSEN IS A MEMBER OF PCMC'S BOARD OF DIRECTORS. | $30,000 | MR. ANDERSEN SERVES AS THE HOSPITAL'S PHARMACIST. | 0 |
| CARLEE HANSEN | |||
| MS. HANSEN IS A MEMBER OF PCMH'S BOARD OF DIRECTORS | $16,200 | THE HOSPITAL RENTS AN APARTMENT FROM MS. HANSEN. | 0 |
| TONY PFAFF | |||
| MR. PFAFF IS PCMH'S CURRENT CEO. | $429,200 | MR. PFAFF IS THE OWNER OF CYPRESS HEALTHCARE, LLC, THE INDEPENDENT CONTRACTOR HIRED TO MANAGE THE HOSPITAL. HE RECEIVES ALL COMPENSATION FOR HIS SERVICES AS CEO FROM CYPRESS HEALTHCARE, LLC. | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE HOSPITAL DELEGATED CONTROL OF MANAGEMENT SERVICES TO CYPRESS HEALTHCARE, LLC. TONY PFAFF, CEO OF THE HOSPITAL, IS THE OWNER OF CYPRESS HEALTHCARE, LLC. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE CEO AND CFO REVIEW THE 990 PRIOR TO ITS FILING. THE BOARD IS THEN INFORMED THE 990 IS AVAILABLE TO BE REVIEWED AT THEIR REQUEST. |
| FORM 990, PART VI, SECTION B, LINE 12C | IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE ORGANIZATION CAN OBTAIN, WITH REASONABLE EFFORTS, A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION DETERMINATION IS A JOINT EFFORT BY THE MANAGEMENT COMPANY AND THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| PART VII, SECTION A, LINE 1A | THE ORGANIZATION'S CEO, TONY PFAFF, IS THE OWNER OF CYPRESS HEALTHCARE, LLC AND RECEIVES NO COMPENSATION FROM DEER LODGE MEDICAL CENTER. SEE SCHEDULE L FOR ADDITIONAL INFORMATION. |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,261,034. MANAGEMENT AND GENERAL EXPENSES 67,638. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,328,672. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 631,077. MANAGEMENT AND GENERAL EXPENSES 53,120. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 684,197. |
| FORM 990, PART XII, LINE 2C: | THE ORGANIZATION HAS A COMMITTEE WHICH ASSUMES OVERSIGHT OF THE AUDIT/REVIEW OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THERE HAVE BEEN NO CHANGES TO THE POLICY IN THE CURRENT YEAR. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL EMERGENCY MEDICAL SERVICES LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 HOLLENBACK LANE | AddressLine1Txt |
| City | DEER LODGE | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 843599616 | EIN |
| Primary Activities | AMBULANCE SERVICE | PrimaryActivitiesTxt |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Total Income | $831,101 | TotalIncomeAmt |
| End Of Year Assets | $421,821 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL COUNTY MEMORIAL HOSPITAL ASSOC | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL COUNTY MEDICAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 HOLLENBACK LANE | AddressLine1Txt |
| City | DEER LODGE | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810438377 | EIN |
| Primary Activities | RAISE FUNDS FOR POWELL COUNTY MEMORIAL HOSPITAL. | PrimaryActivitiesTxt |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12C, III-FI | PublicCharityStatusTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt |
|---|---|
| POWELL COUNTY MEDICAL FOUNDATION | |
| C | $52,268 |
| POWELL COUNTY MEDICAL FOUNDATION | |
| O | $1,842 |