2022-04-12T17:30:47-05:00 2021-06-30 390758449 WIPFLI LLP 101 EAST FRONT STREET 301 MISSOULA MT 59802 990 2020-07-01 810245848 ROUNDUP MEMORIAL HOSPITAL ASSOCIATION ROUN 4063232301 PO BOX 40 ROUNDUP MT 59072 HOLLY WOLFF CEO 4063232301 2022-04-08 1 HOLLY WOLFF 999009999 SAM BRUNSON CPA P01696998 4067281800 2022-04-08 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z HOLLY WOLFF PO BOX 40 ROUNDUP MT 59072 15478684 0 X WWW.RMHMT.ORG X 1979 MT PROVIDE HEALTHCARE SERVICES 7 7 141 30 0 0 1549056 3296226 9839058 11961059 4918 12849 397271 208550 11790303 15478684 0 0 0 0 4437303 4929542 0 0 0 5183307 6088665 9620610 11018207 2169693 4460477 11993764 14681617 5438721 3746531 6555043 10935086 X IT IS THE MISSION OF THE ROUNDUP MEMORIAL HOSPITAL TO ACCEPT THE ONGOING CHALLENGE OF PROVIDING FOR THE HEALTHCARE NEEDS OF ALL OF OUR CITIZENS. IT IS OUR SINCERE DESIRE TO HEAL THE SICK AND COMFORT THE SUFFERING WITH ALL THE RESOURCES WE HAVE AVAILABLE. AS GOOD STEWARDS OF THESE INSTITUTIONS, EMPLOYEES WILL HELP ENSURE THE SURVIVAL OF THE HOSPITAL BY BEING COMMITTED TO THE CARE AND WELL-BEING OF THOSE THEY SERVE. 0 0 9712223 12169609 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. 9712223 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 27 0 141 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 1 1 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X ROUNDUP MEMORIAL HOSPITAL ASSOCIATION 4063232301 1202 THIRD STREET WEST ROUNDUP MT 59702 X JOHN PFISTER PRESIDENT 1.00 X X 0 0 0 MARK ROSEBUSH DMD VICE PRESIDENT 0.50 X X 0 0 0 KEN MOSDAL TREASURER 0.50 X X 0 0 0 BRYAN ADOLPH DIRECTOR 0.50 X 0 0 0 LEONARD WALL DIRECTOR 0.50 X 0 0 0 MARSHALL WHITE MD DIRECTOR 0.50 X 0 0 0 DAVE LIGGETT DIRECTOR 0.50 X 0 0 0 HOLLY WOLFF CEO 40.00 X 0 0 0 ANNE MARIE KLOPPEL CFO 40.00 X 0 0 0 BRYNN BIXBY PA 40.00 X 153626 0 239 VALERI RUSSELL PA 40.00 X 148049 0 7366 CHARLES FOWLER NP 40.00 X 105628 0 5901 407303 0 13506 3 0 1 0 BILLINGS CLINIC PO BOX 30357 BILLINGS MT 59107 MANAGEMENT SERVICES 556042 PRAIRIE TRAVELERS 130 3RD STREET S 2 GLASGOW MT 59230 HEALTHCARE STAFFING 237102 YELLOWSTONE VALLEY TRAVELERS PO BOX 51197 BILLINGS MT 59105 HEALTHCARE STAFFING 202971 WILDERNESS MEDICAL STAFFING 1124 W RIVERSIDE AVE 215 SPOKANE WA 99201 HEALTHCARE STAFFING 188029 TW CLARK CONTSTRUCTION 609 CHARLES STREET BILLINGS MT 59101 CONTRACTOR 164954 7 2541283 754943 3296226 INPATIENT/OUTPATIENT REVENUE 621110 11147954 11147954 OTHER OPERATING REVENUE 900099 693814 693814 340B REVENUE 446110 119291 119291 11961059 12199 12199 720 0 720 720 720 650 0 650 650 650 TAX REVENUE 900099 157970 157970 REBATES/REFUNDS 900099 49860 49860 207830 15478684 12169609 0 12849 X 4114569 3933995 180574 35585 29847 5738 412431 345924 66507 366957 307783 59174 91344 91344 38560 38560 32132 32132 2707167 2351244 355923 8640 7776 864 36540 32886 3654 234806 205049 29757 130988 117889 13099 26631 13925 12706 30570 30570 541775 539633 2142 65892 9011 56881 MEDICAL SUPPLIES 802074 802074 REPAIRS & MAINTENANCE 256512 256512 GENERAL SUPPLIES 248048 186276 61772 SMALL EQUIPMENT 174965 174965 662021 397434 264587 11018207 9712223 1305984 0 2318527 12274 4320407 5821862 1091728 1333539 135349 154721 164055 179682 15871622 9551710 3603683 6319912 11100 11509 348915 848118 11993764 14681617 592380 995759 3346646 1377409 1499695 1373363 5438721 3746531 X 6468618 10525268 86425 409818 6555043 10935086 11993764 14681617 4460477 -80434 0 X X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8420378 5359247 3061131 7089764 4192463 2897301 361480 361480 6319912 COST REPORT SETTLEMENT 632226 BED TAX RECEIVABLE 215892 848118 X 15081676 0 15081676 397008 397008 15478684 10621199 0 10621199 397008 397008 11018207 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 165,609. EXPENSES NETTED AGAINST MISCELLANEOUS INCOME 200,829. INTEREST EXPENSE 30,570. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 165,609. EXPENSES NETTED AGAINST MISCELLANEOUS INCOME 200,829. INTERST EXPENSE 30,570. 1 1 1 X 125.000000000000 1 X 1 1 0 0 94009 94009 0.00850 2845873 2285835 560038 0.05080 2939882 2285835 654047 0.05930 24061 6586 17475 0.00160 24061 6586 17475 0.00160 2963943 2292421 671522 0.06090 0 165609 66244 3942920 3942382 538 X 1 1 1 1 ROUNDUP MEMORIAL HOSPITAL ASSOCIATION 1202 3RD STREET WEST ROUNDUP MT 59072 X X RURAL HEALTH CLINIC ROUNDUP MEMORIAL HOSPITAL ASSOC 1 0 0 1 X X X X X X X X 20 1 0 1 1 X WWW.RMHMT.ORG X 1 20 1 WWW.RMHMT.ORG 0 1 X 125.000000000000 200.000000000000 1 1 X X X X 1 X WWW.RMHMT.ORG X WWW.RMHMT.ORG X X 1 X 0 X 1 X 0 0 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. 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 10 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. 0 0 0 0 0 0 0 0 0 VALERI RUSSELL PA 148049 0 0 0 0 0 0 0 7366 0 155415 0 0 0 BRYNN BIXBY PA 153626 0 0 0 0 0 0 0 239 0 153865 0 0 0 BILLINGS CLINIC INC ORGANIZATION'S CEO & CFO ARE EMPLOYEES OF BILLINGS CLINIC 711048 HOLLY WOLFF, CEO, AND ANNE MARIE KLOPPEL, CFO, ARE EMPLOYEES OF THE BILLINGS CLINIC, INC., THE INDEPENDENT CONTRACTOR HIRED TO MANAGE THE HOSPITAL, AND RECEIVED ALL COMPENSATION FOR THEIR SERVICES AS CEO AND CFO, RESPECTIVELY, FROM BILLINGS CLINIC, INC. 0 FORM 990, PART VI, SECTION A, LINE 2 LEONARD WALL AND BRYAN ADOLPH - FAMILY RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS CONTRACTED WITH BILLINGS CLINIC TO PROVIDE MANAGEMENT SERVICES. 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 2,269,842. MANAGEMENT AND GENERAL EXPENSES 332,254. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,602,096. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 81,402. MANAGEMENT AND GENERAL EXPENSES 23,669. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 105,071. 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.