ROUNDUP MEMORIAL HOSPITAL ASSOCIATION: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- ROUNDUP MEMORIAL HOSPITAL ASSOCIATION (EIN 81-0245848)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-09
- IRS object ID
- 202321299349301437
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-09T11:56:24-05:00 | 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 | 810245848 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROUNDUP MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ROUN | BusinessNameControlTxt |
| Phone | 4063232301 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 40 | AddressLine1Txt |
| City | ROUNDUP | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59072 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | HOLLY WOLFF | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 4063232301 | PhoneNum |
| Signature | 2023-05-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | HOLLY | PersonFirstNm |
| Person Last | WOLFF | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SAM BRUNSON CPA | PreparerPersonNm |
| PTIN | P01696998 | PTIN |
| Phone | 4067281800 | PhoneNum |
| Preparation | 2023-05-02 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | HOLLY WOLFF | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 40 | AddressLine1Txt |
| City | ROUNDUP | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59072 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,792,756 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.RMHMT.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1979 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | PROVIDING HEALTHCARE THAT IS CAREFUL, COMPETENT AND KIND. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 140 | TotalEmployeeCnt |
| Total Volunteers | 30 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,296,226 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,556,981 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $11,961,059 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $13,682,835 | CYProgramServiceRevenueAmt |
| PY Investment Income | $12,849 | PYInvestmentIncomeAmt |
| CY Investment Income | -$1,428 | CYInvestmentIncomeAmt |
| PY Other Revenue | $208,550 | PYOtherRevenueAmt |
| CY Other Revenue | $546,689 | CYOtherRevenueAmt |
| PY Total Revenue | $15,478,684 | PYTotalRevenueAmt |
| CY Total Revenue | $15,785,077 | 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 | $4,929,542 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,569,172 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,088,665 | PYOtherExpensesAmt |
| CY Other Expenses | $7,167,201 | CYOtherExpensesAmt |
| PY Total Expenses | $11,018,207 | PYTotalExpensesAmt |
| CY Total Expenses | $12,736,373 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,460,477 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,048,704 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $14,681,617 | TotalAssetsBOYAmt |
| Total Assets EOY | $15,610,373 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,746,531 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,626,583 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,935,086 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $13,983,790 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WE AIM TO DELIVER SAFE, PATIENT-CENTERED CARE WITH THE KINDNESS WE WOULD WANT FOR OURSELVES AND OUR FAMILY. WE STRIVE TO OFFER QUALITY CARE AND PROGRAMS THAT MEET OUR COMMUNITY'S NEEDS, EXCEED PATIENT EXPECTATIONS, AND ARE OFFERED IN A CARING, CONVENIENT, COST-EFFECTIVE, AND ACCESSIBLE SPACE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $11,455,735 | ExpenseAmt |
| Revenue | $14,229,524 | RevenueAmt |
| Desc | CRITICAL ACCESS HOSPITAL - ROUTINE SERVICE FOR ADULTS, PEDIATRICS, AND SWING BED. RURAL HEALTH CLINIC WITH FOUR PROVIDERS. OTHER SERVICES INCLUDE BUT ARE NOT LIMITED TO ANCILLARIES; CT SCANS; LABORATORY; PHYSICAL, THERAPIES AND REHABILITATION; PHARMACY; EMERGENCY ROOM; X-RAY; DEXASCAN; CHRONIC CARE AND DIABETES MANAGEMENT; CENTRAL SUPPLY; INTRAVENOUS SOLUTIONS; ULTRASOUND; ELECTROCARDIOGRAPHY; OBSERVATION; BLOOD BANK; AND PATHOLOGY. RMH IMPLEMENTED STOP THE BLEED PROGRAM AND PROVIDED EDUCATION AND FREE RESOURCES TO THE COMMUNITY OF ROUNDUP AND SURROUNDING TOWNS IN OUR SERVICE REGION. THE TWO INSTRUCTORS WERE A PROVIDER AND OUR TRAUMA COORDINATOR, BOTH FORMALLY CERTIFIED TO TEACH STOP THE BLEED. THEY TAUGHT THESE LIFE-SAVING SKILLS TO DIFFERENT AUDIENCES INCLUDING SCHOOL-AGED TEENS, THE RETIRED COMMUNITY, THOSE IN AGRICULTURE, AND MANY IN VOLUNTEER ROLES WITHIN THE COMMUNITY.DUE TO THE CONTINUED SAFETY CONCERNS OF THE PANDEMIC AND REGULATIONS FOR HEALTHCARE WORKERS, RMH HAS NOT PUT ON THE HEALTH FAIR THIS PAST YEAR. WE ARE HOPING TO REINSTITUTE THIS COMMUNITY BENEFIT SOON. | Desc |
| Total Program Service Expenses | $11,455,735 | 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 | 0 | 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 | 0 | TaxExemptBondsInd |
| 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 | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | 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 | 0 | 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 | 27 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 140 | 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 | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | 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 | ROUNDUP MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4063232301 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1202 THIRD STREET WEST | AddressLine1Txt |
| City | ROUNDUP | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59702 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| JOHN PFISTER | |||||||
| CHAIR | 2.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARK ROSEBUSH DMD | |||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KEN MOSDAL | |||||||
| SECRETARY/TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BRYAN ADOLPH | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LEONARD WALL | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARSHALL WHITE MD | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| NICOLE BORNER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| HOLLY WOLFF | |||||||
| CEO | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| LORIE HUTCHISON | |||||||
| PROVIDER | 40.00 | $206,800 | $0 | $144 | Yes (X) | ||
| VALERI RUSSELL | |||||||
| PROVIDER | 40.00 | $137,294 | $0 | $25,707 | Yes (X) | ||
| BRYNN BIXBY | |||||||
| PROVIDER | 40.00 | $170,183 | $0 | $3,789 | Yes (X) | ||
| CYNTHIA MOORE | |||||||
| DON | 40.00 | $106,131 | $0 | $18,281 | Yes (X) | ||
| ALEX GOFFENA | |||||||
| NURSE MANAGER | 40.00 | $113,480 | $0 | $14,632 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $733,888 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $62,553 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | 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 |
|---|---|---|---|---|---|
| MEDICAL SOLUTIONS | |||||
| PO BOX 850737 | MINNEAPOLIS | MN | 554850737 | CONTRACT PROVIDERS | $2,018,405 |
| WILDERNESS MEDICAL STAFFING | |||||
| PO BOX 30729 | SPOKANE | WA | 99223 | CONTRACT PROVIDERS | $416,364 |
| YELLOWSTONE VALLEY TRAVELERS | |||||
| PO BOX 51197 | BILLINGS | MT | 59105 | CONTRACT NURSING STAFF | $329,660 |
| FOREFRONT HEALTHCARE | |||||
| PO BOX 33661 | DETROIT | MI | 48232 | CONTRACT DIETARY STAFF | $321,361 |
| BILLINGS CLINIC | |||||
| PO BOX 30357 | BILLINGS | MT | 59107 | MANAGEMENT SERVICES | $110,032 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $297,725 | GovernmentGrantsAmt |
| All Other Contributions | $1,259,256 | AllOtherContributionsAmt |
| Total Contributions | $1,556,981 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621110 | $12,827,217 | $12,827,217 |
| OTHER OPERATING REVENUE | 900099 | $679,415 | $679,415 |
| 340B REVENUE | 446110 | $176,203 | $176,203 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $13,682,835 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,251 | TotalRevenueColumnAmt |
| Exclusion | $6,251 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $720 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $720 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $720 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $720 | RelatedOrExemptFuncIncomeAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $7,679 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$7,679 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$7,679 | TotalRevenueColumnAmt |
| Exclusion | -$7,679 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| TAX REVENUE | 900099 | $514,453 | $514,453 |
| REBATES/REFUNDS | 900099 | $31,516 | $31,516 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $545,969 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,785,077 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,229,524 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$1,428 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,795,357 | TotalAmt |
| Program Services | $4,584,906 | ProgramServicesAmt |
| Management And General | $210,451 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,687 | TotalAmt |
| Program Services | $21,545 | ProgramServicesAmt |
| Management And General | $4,142 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $357,325 | TotalAmt |
| Program Services | $299,704 | ProgramServicesAmt |
| Management And General | $57,621 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $390,803 | TotalAmt |
| Program Services | $327,783 | ProgramServicesAmt |
| Management And General | $63,020 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,358 | TotalAmt |
| Program Services | $19,355 | ProgramServicesAmt |
| Management And General | $80,003 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,882 | TotalAmt |
| Program Services | $5,237 | ProgramServicesAmt |
| Management And General | $21,645 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,165 | TotalAmt |
| Program Services | $7,629 | ProgramServicesAmt |
| Management And General | $31,536 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,325,532 | TotalAmt |
| Program Services | $2,859,890 | ProgramServicesAmt |
| Management And General | $465,642 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,635 | TotalAmt |
| Program Services | $3,272 | ProgramServicesAmt |
| Management And General | $363 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,804 | TotalAmt |
| Program Services | $63,471 | ProgramServicesAmt |
| Management And General | $12,333 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $262,015 | TotalAmt |
| Program Services | $228,809 | ProgramServicesAmt |
| Management And General | $33,206 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $234,557 | TotalAmt |
| Program Services | $164,171 | ProgramServicesAmt |
| Management And General | $70,386 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,334 | TotalAmt |
| Program Services | $27,888 | ProgramServicesAmt |
| Management And General | $25,446 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,510 | TotalAmt |
| Program Services | $5,549 | ProgramServicesAmt |
| Management And General | $28,961 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,625 | TotalAmt |
| Management And General | $26,625 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $781,918 | TotalAmt |
| Program Services | $778,827 | ProgramServicesAmt |
| Management And General | $3,091 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,938 | TotalAmt |
| Program Services | $11,068 | ProgramServicesAmt |
| Management And General | $69,870 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $928,442 | $928,442 | |
| BAD DEBT EXPENSE | $377,510 | $377,510 | |
| REPAIRS & MAINTENANCE | $221,991 | $221,991 | |
| GENERAL SUPPLIES | $178,055 | $133,714 | $44,341 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $416,930 | TotalAmt |
| Program Services | $384,974 | ProgramServicesAmt |
| Management And General | $31,956 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,736,373 | TotalAmt |
| Program Services | $11,455,735 | ProgramServicesAmt |
| Management And General | $1,280,638 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,274 | BOYAmt |
| EOY | $24,453 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,821,862 | BOYAmt |
| EOY | $6,115,735 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,333,539 | BOYAmt |
| EOY | $2,253,356 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $154,721 | BOYAmt |
| EOY | $170,554 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $179,682 | BOYAmt |
| EOY | $191,980 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $16,461,850 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,333,632 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,319,912 | BOYAmt |
| EOY | $6,128,218 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,509 | BOYAmt |
| EOY | $8,622 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $848,118 | BOYAmt |
| EOY | $717,455 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,681,617 | BOYAmt |
| EOY | $15,610,373 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $995,759 | BOYAmt |
| EOY | $747,830 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,377,409 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,373,363 | BOYAmt |
| EOY | $878,753 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,746,531 | BOYAmt |
| EOY | $1,626,583 | 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 | $10,525,268 | BOYAmt |
| EOY | $13,638,961 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $409,818 | BOYAmt |
| EOY | $344,829 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,935,086 | BOYAmt |
| EOY | $13,983,790 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,681,617 | BOYAmt |
| EOY | $15,610,373 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $3,048,704 | ReconcilationRevenueExpnssAmt |
| 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
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,726,565 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,859,933 | DepreciationAmt |
| Book Value | $2,866,632 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,588,497 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,473,699 | DepreciationAmt |
| Book Value | $3,114,798 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $146,788 | OtherCostOrOtherBasisAmt |
| Book Value | $146,788 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,128,218 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $15,159,404 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $15,159,404 | RevenueSubtotalAmt |
| Other Revenues Not Included | $625,673 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $625,673 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $15,785,077 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $12,110,700 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $12,110,700 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $625,673 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $625,673 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $12,736,373 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 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. THE HOSPITAL APPLIES GENERALLY ACCEPTED ACCOUNTING PRINCIPLES FOR RECOGNITION OF UNCERTAINTY IN INCOME TAXES AND PRESCRIBING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. IN THE COURSE OF ITS ASSESSMENT, THE HOSPITAL HAS DETERMINED THAT IT IS SUBJECT TO EXAMINATION OF ITS INCOME TAX FILINGS IN THE UNITED STATES AND STATE JURISDICTIONS FOR THE PRIOR THREE TAX YEARS. IN THE EVENT THAT THE HOSPITAL IS ASSESSED PENALTIES AND OR INTEREST, PENALTIES WILL BE CHARGED TO MISCELLANEOUS EXPENSE AND INTEREST WILL BE CHARGED TO INTEREST EXPENSE. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 377,510. EXPENSES NETTED AGAINST MISCELLANEOUS INCOME 221,538. INTEREST EXPENSE 26,625. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 377,510. EXPENSES NETTED AGAINST MISCELLANEOUS INCOME 221,538. INTERST EXPENSE 26,625. |
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 | 125.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| 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 | $150,563 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $150,563 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01180 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,093,652 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,470,456 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $623,196 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04890 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,244,215 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,470,456 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $773,759 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06070 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,850 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,125 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $18,725 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $164,828 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $164,828 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01290 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $187,678 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,125 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $183,553 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01440 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,431,893 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,474,581 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $957,312 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07510 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,631 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,631 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,631 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,631 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $377,510 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $151,005 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $4,319,750 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,293,725 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $26,025 | 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 |
| 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 | ROUNDUP MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1202 3RD STREET WEST | AddressLine1Txt |
| City | ROUNDUP | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59072 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.RMHMT.ORG | WebsiteAddressTxt |
| State License | 13511 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | RURAL HEALTH CLINIC | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROUNDUP MEMORIAL HOSPITAL ASSOC | 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 | 20 | 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.RMHMT.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.RMHMT.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 | 125.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| 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 |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.RMHMT.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.RMHMT.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.RMHMT.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 |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| None Made | Yes (X) | NoneMadeInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ROUNDUP MEMORIAL HOSPITAL ASSOC | PART V, SECTION B, LINE 5: THE STEERING COMMITTEE CREATED TO ASSIST ROUNDUP MEMORIAL HEALTHCARE IN CONDUCTING CHSD WAS SELECTED TO REPRESENT A BROAD GROUP ACROSS THE COMMUNITY BUT DIFFERENTIATE FROM THE PAST CHNA. A DIVERSE GROUP OF COMMUNITY MEMBERS REPRESENTING VARIOUS ORGANIZATIONS AND POPULATIONS WITHIN THE COMMUNITY (EX. PUBLIC HEALTH, ELDERLY, UNINSURED, MALE) CAME TOGETHER IN FEBRUARY 2021. 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, CONSIDERING APPROPRIATE CANDIDATES FOR TARGETED KEY INTERVIEWS (DUE TO INABILITY TO CONDUCT FOCUS GROUPS) AND MEETING AGAIN TO REVIEW RESULTS OF THE SURVEY AND TO ASSIST IN THE PRIORITIZATION OF HEALTH NEEDS WHEN CREATING THE IMPLEMENTATION PLAN. |
| ROUNDUP MEMORIAL HOSPITAL ASSOC | PART V, SECTION B, LINE 6B: THE MONTANA OFFICE OF RURAL HEALTHTHE NATIONAL RURAL HEALTH RESOURCE CENTER |
| ROUNDUP MEMORIAL HOSPITAL ASSOC | PART V, SECTION B, LINE 11: THE FOLLOWING SUMMARY BRIEFLY REPRESENTS THE GOALS AND CORRESPONDING STRATEGIES AND ACTIVITIES WHICH THE FACILITY WILL EXECUTE TO ADDRESS THE PRIORITIZED HEALTH NEEDS.GOAL 1: IMPROVE ACCESS TO MENTAL AND BEHAVIORAL HEALTH RESOURCES IN MUSSELSHELL COUNTY.STRATEGY 1.1: ENHANCE THE CAPACITY OF THE MENTAL AND BEHAVIORAL HEALTH WORKFORCE AT RMH.RECRUIT A CHRONIC CONDITIONS MANAGER THAT WILL INHERENTLY ALSO CHAMPION MENTAL AND BEHAVIORAL HEALTH INITIATIVES AT RMH.EXPLORE MORH/AHEC'S BEHAVIORAL HEALTH TRAINING PERTINENCE TO RMH STAFF AND AREA PROVIDERS IN ENHANCING MENTAL AND BEHAVIORAL HEALTH SKILLS, KNOWLEDGE, AND TRAINING (HEALTHINFO.MONTANA.EDU/BHWET/TRAININGS).EXAMINE THE VARIOUS MENTAL HEALTH MODELS THAT HAVE BEEN IMPLEMENTED REGIONALLY. ASSESS THE FEASIBILITY FOR INTEGRATING A COMPLEMENTARY MODEL INTO RMH PRACTICE.DEVELOP PROTOCOL AND BEST PRACTICES FOR BOTH THE RMH CLINIC AND HOSPITAL SETTINGS REGARDING SCREENING AND REFERRALS FOR A MENTAL HEALTH CRISIS.STRATEGY 1.2: LEVERAGE REGIONAL PARTNERSHIPS TO ALIGN MENTAL AND BEHAVIORAL HEALTH RESOURCES AND INITIATIVES LOCALLY.FOSTER RELATIONSHIPS WITH COMMISSIONERS PARTICIPATING IN BILLINGS MENTAL HEALTH BOARD AND OTHER REGIONAL MENTAL HEALTH COALITIONS. SUPPORT RMH PARTICIPATION ON THESE BOARDS AND COALITIONS.PARTNER WITH THE LOCAL SCHOOLS TO EXPLORE OPPORTUNITIES THAT IMPROVE MENTAL AND BEHAVIORAL HEALTH OUTCOMES FOR AREA YOUTH. NURTURE A RESILIENT RELATIONSHIP WITH THE NEW GUIDANCE COUNSELOR AT ROUNDUP HIGH SCHOOL.STRATEGY 1.3: IMPROVE AWARENESS OF AVAILABLE MENTAL AND BEHAVIORAL HEALTH RESOURCES THROUGH ENHANCED OUTREACH AND EDUCATION INITIATIVES.EXPLORE EVIDENCE-BASED STRATEGIES THAT THE COMMUNITY COULD ADOPT FOR REDUCING THE STIGMA ASSOCIATED WITH ACCESSING MENTAL AND BEHAVIORAL HEALTH RESOURCES.CREATE AND DOCUMENT A STRATEGY TO EDUCATE RMH STAFF ON THE MENTAL HEALTH REFERRALS, PROTOCOL, AND AVAILABLE RESOURCES DEVELOPED IN ACTIVITY 1.1.4.DEVELOP A COMMUNITY OUTREACH AND EDUCATION CAMPAIGN FOR MENTAL HEALTH RESOURCES THAT ARE AVAILABLE LOCALLY.GOAL 2: ENHANCE AWARENESS OF HEALTH RESOURCES IN MUSSELSHELL COUNTY THROUGH THE IMPROVEMENT OF OUTREACH AND EDUCATION EFFORTS.STRATEGY 2.1: ENHANCE RMH OUTREACH EFFORTS OF AVAILABLE HEALTH SERVICES AND RESOURCES.DEVELOP A COMPREHENSIVE HEALTH COMMUNICATION PLAN FOR RMH THAT PRIORITIZES AVENUES SUCH AS WEB PRESENCE AND SOCIAL MEDIA.EXPLORE OPPORTUNITIES TO ENHANCE THE RMH WEBSITE'S OPERABILITY AND PATIENT/USER-FRIENDLINESS, STREAMLINING ACCESS TO LOCAL HEALTH INFORMATION AND RESOURCES.STRATEGY 2.2: REINVIGORATE RMH'S PRESENCE IN THE COMMUNITY AS A SOURCE FOR HEALTH EDUCATION AND RESOURCES, PARTICULARLY RELATED TO PREVENTIVE SERVICES AND CHRONIC DISEASE MANAGEMENT.DESIGN EDUCATIONAL CAMPAIGNS TAILORED TO THE COMMUNITY AND RMH PROVIDERS THAT DESCRIBE RMH'S PARTNERSHIP WITH THE EASTERN MONTANA TELEMEDICINE NETWORK, ENHANCING ACCESS, REDUCING HEALTHCARE TRAVEL BURDEN AND COSTS FOR THE COMMUNITY.HOST AND PROMOTE AN ANNUAL HEALTH FAIR. IF THE NEED IS DETERMINED AMONG COMMUNITY MEMBERS, RMH WILL CONSIDER SPONSORING TARGETED HEALTH FAIRS IN THE SPRING AND FALL. IN ADDITION, CONTINUE COLLABORATING WITH LOCAL PARTNERS TO HIGHLIGHT COMMUNITY-BASED RESOURCES AT THE HEALTH FAIR(S).EXPLORE AND IMPLEMENT PREVENTIVE HEALTH PROGRAMMING INCLUDING, BUT NOT LIMITED TO, WALK WITH EASE, ELDERLY FALL PREVENTION, STOP THE BLEED, AND AN ARTHRITIS FOUNDATION PROGRAM.PRESERVE RMH'S PRESENCE IN THE COMMUNITY AS A TRUSTED PARTNER IN ADDRESSING EMERGENT HEALTH ISSUES, SUCH AS COVID-19. CONTINUE SPONSORING TIMELY EFFORTS SUCH AS PROVIDING HAND SANITIZER, HANDWASHING EDUCATION, VACCINATION CONFIDENCE, ETC., TO THE COMMUNITY.GOAL 3: REVIVE CHRONIC DISEASE MANAGEMENT AND PREVENTION EFFORTS IN MUSSELSHELL COUNTY.STRATEGY 3.1: LEVERAGE PARTNERSHIP WITH BILLINGS CLINIC TO ENHANCE CHRONIC DISEASE MANAGEMENT AND PREVENTION.DEVELOP A PROTOCOL TO IDENTIFY AND REFER TO THE CHRONIC DISEASE MANAGEMENT PROGRAM. BEGIN BY INCLUDING HEART FAILURE PREVENTION, COMMUNITY HEALTH WORKER, CARE COORDINATION, MEDICATION ADHERENCE, AND EDUCATION COMPONENTS IN THE RMH CLINIC. THEN, AS DEEMED FEASIBLE, RMH WILL EXPLORE EXPANDING THE PROGRAM INTO THE HOSPITAL.UTILIZE EVIDENCE-BASED RESOURCES TO DEVELOP OUTREACH MATERIALS THAT EDUCATE AND REFER ELIGIBLE PATIENTS TO THE CHRONIC DISEASE MANAGEMENT PROGRAM.STRATEGY 3.2: COLLABORATE WITH COMMUNITY PARTNERS TO ALLEVIATE BARRIERS TO HEALTHY EATING.EXPLORE HOW BEST TO PARTNER WITH COMMUNITY ORGANIZATIONS IN OFFERING HEALTHIER FOOD OPTIONS AS WELL AS WITHIN THE HOSPITAL [RHI TOOLKITS, CONVERSATIONS WITH COMMUNITY PARTNERS (NEW COMMUNITY MARKET, FOOD BANK, ETC.)].EXPLORE OPPORTUNITIES FOR DISSEMINATING HEALTHY EATING AND NUTRITION EDUCATION AT LOCAL EVENTS SUCH AS THE COMMUNITY MARKET. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE COST-TO-CHARGE RATIO WAS USED TO CALCULATE THE FIGURES IN THE TABLE. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. |
| PART I, LN 7 COL(F): | THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX, LINE 25 HAS BEEN SUBTRACTED FROM TOTAL OPERATING EXPENSES IN THE CALCULATION OF THE COST-TO-CHARGE RATIO FROM WORKSHEET 2. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | THE CEO NOW SITS ON THE ROUNDUP COMMUNITY PARTNERS COMMITTEE TO WORK ON COMMUNITY EFFORTS IN PROMOTING HOSPITAL-LED PARTICIPATION. THE HOSPITAL COMMITTEE, PATIENTS AND FAMILY ADVISORY COMMITTEE (PFAC) HAS RECRUITED A COMMUNITY MEMBER TO ACT AS AN ADVISORY ROLE IN PROVIDING INPUT AND INSIGHT FROM THE COMMUNITY PERSPECTIVE. |
| PART III, LINE 2: | NET BAD DEBT EXPENSE RECORDED IN THE GENERAL LEDGER (EXPENSE LESS RECOVERIES). |
| PART III, LINE 3: | WE ESTIMATE APPROXIMATELY 40% OF TOTAL BAD DEBT IS ATTRIBUTABLE TO PATIENTS THAT WOULD LIKELY BE ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. |
| PART III, LINE 4: | THE FOOTNOTE DESCRIBING BAD DEBT IS ON PAGE 12 OF THE ATTACHED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | THE ENTIRE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. MEDICARE RATES DO NOT ALWAYS ALIGN WITH THE ACTUAL COSTS OF TREATMENT. BY CONTINUING TO TREAT PATIENTS ELIGIBLE UNDER MEDICARE, THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE ORGANIZATION USED AMOUNTS FROM THEIR MEDICARE COST REPORT TO DETERMINE LINE 6. |
| PART III, LINE 9B: | POLICY STATES UP FRONT THAT ADMISSIONS REPRESENTATIVE IS TO GIVE FINANCIAL ASSISTANCE PAPERWORK WITH INFORMAION ON CHARITY CARE AT THE TIME OF ADMISSION. FOLLOW UP CONSULTATION IS DONE LATER TO INCLUDE FINANCIAL ASSISTANCE DISCUSSIONS WITH PATIENT. |
| PART VI, LINE 2: | IN 2021, THE HOSPITAL CONDUCTED A NEEDS ASSESSMENT. THE STEERING COMMITTEE INCLUDED REPRESENTATIVES FROM THE LOCAL BUSINESSES, EMS, PUBLIC HEALTH, THE SCHOOL SYSTEM, AGENCY ON AGING, AND LOCAL GOVERNMENT IN ADDITION TO THE HOSPITAL CLINICAL AND ADMINISTRATIVE STAFF. KEY INTERVIEWS AND INFORMANT MEETINGS WERE HELD TO GATHER INFORMATION ON HEALTHCARE NEEDS AND GAPS IN SERVICES. |
| PART VI, LINE 3: | WHEN A PATIENT INDICATES THAT A FINANCIAL HARDSHIP EXISTS, THE HOSPITAL PROVIDES INFORMATION ON THE HOSPITAL CHARITY PLAN AND OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS. |
| PART VI, LINE 4: | ROUNDUP MEMORIAL HEALTHCARE (RMH) IS THE SOLE COMMUNITY HEALTHCARE PROVIDER FOR MUSSELSHELL COUNTY, A RURAL AREA WITH A POPULATION DENSITY OF 2.4 PER SQUARE MILE. NO OTHER HOSPITALS SERVE THE COMMUNITY, AND THE NEAREST HEALTHCARE FACILITY IS LOCATED IN BILLINGS, 45 MILES TO THE SOUTH. PER THE 2020 FEDERAL CENSUS, THE COUNTY POPULATION WAS 4,730; THE PER CAPITA INCOME IN THE COUNTY IS $24,979 AND THE PERCENTAGE OF PERSONS BELOW THE POVERTY LINE WAS 15.4 PERCENT. IN 2010, 13.4 PERCENT OF MUSSELSHELL COUNTY WAS UNINSURED. THE HEALTH RESOURCES AND SERVICES ADMINISTRATION HAS DESIGNATED MUSSELSHELL COUNTY AS AN UNDERSERVED AREA WITH A SCORE OF 16. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LORIE HUTCHISON | ||||||||||||||
| PROVIDER | $206,800 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $144 | $0 | $206,944 | $0 | $0 | $0 |
| BRYNN BIXBY | ||||||||||||||
| PROVIDER | $170,183 | $0 | $0 | $0 | $0 | $0 | $3,542 | $0 | $247 | $0 | $173,972 | $0 | $0 | $0 |
| VALERI RUSSELL | ||||||||||||||
| PROVIDER | $137,294 | $0 | $0 | $0 | $0 | $0 | $3,277 | $0 | $22,430 | $0 | $163,001 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | LEONARD WALL, BRYAN ADOLPH, AND VAL RUSSELL HAVE A FAMILY RELATIONSHIP. |
| FORM 990, PART VI, SECTION A, LINE 3 | THE ORGANIZATION HAS CONTRACTED WITH BILLINGS CLINIC TO PROVIDE MANAGEMENT SERVICES. THE ORGANIZATION'S CURRENT CEO, HOLLY WOLFF, IS AN EMPLOYEE OF BILLINGS CLINIC AND COMPENSATION FOR SERVICES PROVIDED TO THE HOSPITAL INCLUDE THE FOLLOWING: BASE SALARY - $132,177 BONUS - $13,000 EMPLOYER CONTRIBUTION TO 403B PLAN - $3,249 EMPLOYER CONTRIBUTION TO MEDICAL AND DENTAL - $18,226 EMPLOYER CONTRIBUTION TO LIFE INSURANCE AND LONG-TERM DISABILITY - $631 |
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBERS OF HOSPITAL ASSOCIATION 501 (C)(3) |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 IS REVIEWED BY THE CEO, CFO, AND CONTROLLER AND IS DISTRIBUTED TO THE BOARD BEFORE FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE COMPLIANCE OFFICER MONITORS AND EVALUATES CONFLICT OF INTEREST ISSUES. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO IS COMPENSATED ACCORDING TO ARRANGEMENTS WITH THE MANAGEMENT AGREEMENT WITH BILLINGS CLINIC, WHO RECOMMENDS THE CEO SALARY TO THE BOARD FOR APPROVAL. THE HOSPITAL UTILIZES THE MONTANA HOSPITAL ASSOCIATION AND ASSOCIATED EMPLOYEES SALARY SURVEY TO DETERMINE SALARIES OF KEY EMPLOYEES. |
| FORM 990, PART VI, SECTION C, LINE 19 | AVAILABLE UPON REQUSET TO THE CEO. |
| FORM 990, PART IX, LINE 11G | CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 2,768,474. MANAGEMENT AND GENERAL EXPENSES 401,770. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,170,244. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 91,416. MANAGEMENT AND GENERAL EXPENSES 63,872. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 155,288. |
| FORM 990, PART XII, LINE 2C: | THERE IS NO SEPARATE COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT. THE BOARD OF DIRECTORS ASSUMES THIS OVERSIGHT RESPONSIBILITY. THE BOARD HIRES THE AUDIT FIRM AND MEETS WITH THE AUDIT TEAM AT THE CONCLUSION OF THE AUDIT. THE BOARD IS ALSO AVAILABLE FOR ANY QUESTIONS THAT ARISE THROUGHOUT THE AUDIT. |