2022-05-10T11:44:14-05:00 2021-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2020-07-01 810231787 Northern Montana Hospital NORT 4062652211 PO Box 1231 Havre MT 595011231 David Henry President/CEO 4062652211 2022-04-29 1 David Henry 999009999 Kim Hunwardsen CPA P00484560 6122536500 2022-04-29 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z David Henry PO Box 1231 Havre MT 595011231 81495532 0 X www.nmhcare.org X 1921 MT Provision of healthcare services. 14 10 726 19 327392 15556 173445 7126843 73090346 73352770 1407758 1007864 4053 -1350 74675602 81486127 85276 87569 0 0 36225972 37093185 0 0 31234 31692766 33666851 68004014 70847605 6671588 10638522 95601103 100637284 27848432 16790765 67752671 83846519 X To deliver high quality comprehensive healthcare services to the Hi-Line communities. 0 0 58230221 87569 73352770 Northern Montana Hospital (Hospital) includes 49 acute care hospital beds, 135 skilled nursing beds, 10 assisted living beds and two medical clinics located in Havre, Montana. The Hospital provides quality healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation of the Hospital, it is recognized that not all individuals possess the ability to purchase these essential services. It is the Hospital's mission to serve the surrounding area by providing healthcare services and healthcare education to all community members. During the year ended June 30, 2021, the Hospital provided $357,248 of medical services, based on charges, to individuals who were determined unable to purchase such services under the Hospital's charity care policy and guidelines. In addition to free care and/or subsidized care, care is also provided at below cost rates to persons covered by governmental programs. Recognizing its mission to the community, services are provided to both Medicare and Medicaid patients. The unreimbursed value of providing care to these patients was $52,232,848 for the year ended June 30, 2021. During the fiscal year ended June 30, 2021 the Hospital provided over 3,700 days of hospital services. The nursing home provided just under 23,000 resident days during the year.The Hospital also provides community care and services through many healthcare activities and programs provided to support the community. These activities include: wellness programs, community education programs, senior services, healthcare screening, special programs for specific groups, published articles, radio programs, and a variety of community supported activities. The Hospital also received many hours of volunteer help from the community residents. 58230221 1 1 0 1 0 0 0 0 1 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 44 0 1 726 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 10 0 1 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 0 X Kim Lucke VP of Finance 4062652211 PO Box 1231 Havre MT 59501 David C Henry President/CEO 53.00 2.00 X X 0 0 0 Miles Hamilton Chair 1.00 1.00 X X 0 0 0 David Leeds Vice Chair 1.00 1.00 X X 0 0 0 Rick Stevens Treasurer 1.00 1.00 X X 0 0 0 Karrie Lien MD Secretary 40.00 1.00 X X 455921 0 41345 Andrew Carlson Trustee 1.00 1.00 X 0 0 0 Debbie Healy Trustee 1.00 1.00 X 0 0 0 Tom Patrick Trustee 1.00 1.00 X 0 0 0 Paul Tuss Trustee 1.00 1.00 X 0 0 0 Kirsten Kammerzell Trustee 1.00 1.00 X 0 0 0 Fr Daniel Wathen Trustee 1.00 1.00 X 0 0 0 Kevin Harada MD Trustee-IPD Member 40.00 1.00 X 494355 0 39035 Gary Grow PhD Trustee - IPD Member 40.00 1.00 X 191758 0 19216 Cameron Acor DPM Chief of Medical Staff 40.00 1.00 X 253619 0 39363 Kim Lucke VP of Finance 53.00 2.00 X 133038 0 26622 Christen Obresley Vice President 51.00 4.00 X 168347 0 19953 Michelle Cameron-Donaldson MD Orthopedic Surgeon 40.00 0.00 X 635659 0 31931 Walter Smith MD Radiologist 40.00 0.00 X 631831 0 40595 Damian Ymzon MD General Surgeon 40.00 0.00 X 557034 0 39795 Vincent Grant MD General Surgeon 40.00 0.00 X 401448 0 8803 Alexandria Rutherford MD Family Practice 40.00 0.00 X 340554 0 16421 4263564 0 323079 34 0 1 0 Slate Healthcare LLC 2100 West Loop South Suite 900 Houston TX 77027 Staffing 4221110 Associated Construction Management 12 North Broadway Belgrade MT 59714 Construction Services 2042998 Hayes Locums LLC 6700 N Andrews Ave Suite 600 Ft Lauderdale FL 33309 Staffing 667212 Fundamental Financial Group Inc 2552 South Lima Street Aurora CO 80014 Staffing 508500 University of Women's Health LLC 59 Bend Park Rd Great Falls MT 59404 Staffing 483594 19 47500 7066843 12500 7126843 Net Patient Service Revenue 621110 49169736 49169736 Pharmacy 446110 21987780 21660388 327392 Healthcare Consulting 900099 384556 384556 Cafeteria Revenue 722210 238679 238679 1572019 1572019 73352770 806695 806695 8055 9405 -1350 -1350 -1350 143964 57205 0 0 143964 57205 201169 201169 81486127 73025378 327392 1006514 X 87569 87569 1868015 1442765 425250 29554441 23916249 5613397 24795 1307327 1057924 248306 1097 1786242 1445475 339268 1499 2577160 2085507 489491 2162 510000 102000 408000 41346 41346 94461 94461 9139071 7930221 1208850 225759 1500 224259 1961241 1057707 901853 1681 1357989 1086391 271598 1822935 1312876 510059 183635 113771 69864 1837632 1368615 469017 1218796 975037 243759 Medical Supplies 10961983 10916738 45245 Contract Labor 1285247 1285247 Equipment Rental and Ma 981795 936011 45784 Recruitment 524765 524765 1520196 1108618 411578 70847605 58230221 12586150 31234 31108638 30439244 14446002 16297661 2426505 2695447 1107413 1435184 68400273 55013144 10686965 13387129 33234444 35029695 88171 72712 2502965 1280212 95601103 100637284 7115128 8275784 6611099 14122205 8514981 27848432 16790765 X 67752671 83846519 67752671 83846519 95601103 100637284 X 10638522 965853 4489473 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7568 7568 0 Part II-B, Line 1: Lobbying portion of association dues: $7,568 1 26381 60409 53737 33053 0 138215 6802 145017 132797 5418 138215 126935 5862 132797 121394 5541 126935 0.00000 1.00000 0.00000 0 1 1 75272 75272 28697778 21162958 7534820 37305680 32656195 4649485 2321543 1193991 1127552 13387129 Liability for Pension Benefits 1726545 Due to Affiliates 32674 CMS Advance Payments 6485180 Estimated Third Party Payable 270582 8514981 X 82461385 965853 965853 81495532 -9405 -9405 81486127 70857010 9405 9405 70847605 0 70847605 Part IV, Line 1b: The custodial funds are not reported on the balance sheet of NMH as they are the personal resource funds of the residents to be used only for their personal needs. If the resident passes, the funds either go to the family or back to the state. They are in no way an asset of the organization. Part V, Line 4: The endowment funds are in the possession of Northern Montana Health Care Foundation, a related organization. The funds are used to provide funding for specific activities and general operations. Part X, Line 2: The Organization believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 4b - Other Adjustments: Rental expenses included in expenses on financial statements -9,405. Part XII, Line 2d - Other Adjustments: Rental expenses included in revenue on Form 990 9,405. 1 1 X 1 X 125.000000000000 1 X 225.000000000000 1 1 0 1 1 3244 157000 157000 0.00220 28175 16309077 16122596 186481 0.00260 31419 16466077 16122596 343481 0.00480 918 918 0.00000 110 650 650 0.00000 11905 10154409 5617382 4537027 0.06400 510 20559 20559 0.00030 12525 10176536 5617382 4559154 0.06430 43944 26642613 21739978 4902635 0.06910 4000 17988 17988 0.00030 4000 17988 17988 0.00030 0 1437767 246433 16160944 16330697 -169753 X 1 1 1 1 Northern Montana Hospital 30 13th Street Havre MT 59501 www.nmhcare.org 12835 X X X 2 provider based rural health clinics Northern Montana Hospital 1 0 0 1 X X X X X X X X X 20 1 0 1 1 X See Section C Supplemental Information X www.bullhook.com and www.hillcountyhealth.com X X 1 20 1 See Section C Supplemental Information 0 1 X 125.000000000000 225.000000000000 X 1 1 X X X 1 X See Supplemental Info X See Supplemental Info X See Supplemental Info X X X X X X 1 X 0 X X X X 1 X 0 1 Northern Montana Hospital Part V, Section B, Line 5: The 2020-2023 Community Health Needs Assessment, which is being conducted during the time of the COVID-19 PHE, this year includes a more focused collaborative effort between the hospital and the Hill County Health Consortium. Northern Montana Hospital partnered with the Hill County Health Consortium to engage the community in a community wide health needs assessment survey tool, process and results. A Facebook survey monkey tool was the technique used to quickly, accurately and reliably provide household-based information about our community's needs. Members of the Hill County Health Consortium, Northern Montana Hospital and other community agencies hit the ground running, sending the survey monkey tool out to the community to help the Northern Montana Hospital collect the primary data. To further gain insight on the health status of our community and surrounding areas that the hospital serves, the following secondary information/data was also reviewed and considered: National statistics, State of Montana statistics, MT DPHHS county/community specific snapshots and facility statistical data and patient care information were utilized in identifying the priority issues for Northern Montana Hospital during this CHNA cycle. Northern Montana Hospital Part V, Section B, Line 6b: The Hill County Health Consortium effort is spearheaded by the Executive Director of Boys & Girls Club of the Hi-Line, the VP and Regulatory & Community Services of Northern Montana Health Care; RN and Director of Hill County Health Department; and CEO of Bull Hook Community Health Center. Northern Montana Hospital Part V, Section B, Line 7d: The CHNA is electronically delivered to every member of the Consortium and NMH. Bullhook Community Health Center and the Hill County Health Department all received hard copies available for distribution. Northern Montana Hospital Part V, Section B, Line 11: Priority Issue One: Facility and Community SafetyNorthern Montana Hospital (NMH) health leaders identified Facility and Community Safety as their top priority. First and foremost, Northern Montana Hospital will provide a safe and considerate work environment for all employees. NMH will have adequate Personal Protective Equipment (PPE) on-site and comprehensive policies on its use and disposal. NMH will guarantee that all employees are educated on pandemic protocols including disaster protocols, which will be included in each employee's annual review. NMH will build a structure to increase our adaptability to quickly bring clarity to situations and be able to change priorities as rapidly as necessary.Throughout FY21 NMH followed federal guidelines and worked with State and local public health officials to keep the facility, staff, and community safe during the COVID-19 pandemic. Hospital staff were educated regarding COVID-19 through The Bridge and in-house email communications. This education and communication included COVID-19 signs and symptoms, Proper Masking Protocols, Travel Restrictions, Testing requirement and Policies for NMHC Employees. The community was educated via press releases. Visitor Guidelines were established and publicized including each revision. The hospital published a series of press releases educating the community on COVID-19. Visitors were fully screened at every place of entry, and everyone was required to wear a mask.The Hospital sponsored, organized, advertised, and staffed the Community Vaccine Clinics for all community members. Two dates were set aside specifically for community educators, who received over 400 vaccinations. Personal Protective Equipment (PPE) was maintained at adequate levels, and hospital staff were contact-traced in cooperation with the Hill County Health Department. Special provisions for pay types were made. All employees remained employed despite department closures. A special COVID-19 Hotline was established for exposed/quarantined employees to have regular contact with the Infection Preventionist.Priority Issue 2: Employee Retention and RecruitmentNMH health leaders identified Employee Retention and Recruitment as their second priority. Maintaining an adequate local workforce ensures safe operations of the hospital while providing high-quality healthcare to the community. Successful recruitment and retention practices will minimize the number and duration of vacancies, which in turn can improve quality of care and ensure that services are provided locally to the community.At NMH our employees are our number one asset. We believe that employee retention involves strategic actions to keep employees motivated and engaged so they elect to remain with the organization reducing employee turnover. During FY21, as our employees dealt with COVID-19 daily and tried to find life balance, NMH promoted our Employee Assistance Program to our employees. This program is free to employees and offers confidential solutions and 24/7 access. Through the EAP, employees can get help with personal, family and work issues. Additionally, NMH made available to all interested employees an education and discussion program title "Resilience in the time of COVID-19". Employees were recognized for their safety efforts related to the COVID-19 pandemic with a Summer Safety Award.NMH made efforts to retain a semblance of traditional services and events for our employees during the height of the pandemic. Virtual visits were provided for our employees to visit with a representative from our employee retirement plan, Open Enrollment was conducted via email, and we took the majority of our Hospital Week activities outdoors. And the Annual Employee Awards Banquet had a virtual twist.We continue to recognize our employees individually through the C.A.R.E. (Compassionately Achieving Remarkable Excellence) and in the "Pickle Barrel". These are recognition programs that allow employees and patients to recognize our staff members. Additionally, we recognize employees and their family members during the graduation season.NMH recognized staff members for their commitment to providing quality community healthcare with a celebration surrounding NMH's designation as a Top 100 Rural Hospital. Each designated healthcare professional week is recognized by the organization with individual department celebrations.NMH believes that some of the best ambassadors for employee recruitment are current employees. We offer referral bonuses to our employees and sign-on bonuses to tour candidates. NMH utilizes social media to promote our open positions and advertises on multiple job boards. Our directors promote and embrace flexibility in scheduling and promote and support an inclusive workplace culture. New employees are welcomed to the organization through an announcement in The Bridge.Priority Issue 3: Behavioral HealthNMH health leaders identified Behavioral Health as their third priority. Mental health is important at every stage of life and affects how people think, feel and act. NMH has made Behavioral Health a significant priority and is committed to reducing the number of individuals whose overall well-being is negatively impacted by addiction and mental illness. NMH has a variety of services available that can positively influence the community's mental health needs and continues to strategize about services that will influence community members mental wellbeing.NMH offer substance use disorder treatment for adults and behavioral health services for adults, adolescents, and children. The providers at the family Medical Center and the Specialty Medical Center use the PHQ-9 screening tool at each visit to assess each patient's depression rating scale. Referrals are made to the behavioral health providers as indicated through the screening tool. Northern Montana Hospital Part V, Section B, Line 16j: In addition, a summary of the financial assistance policy is posted in the facility's emergency room and waiting rooms as well as admissions offices. The hospital's "Conditions of Treatment" also includes information regarding the financial assistance policy. Northern Montana Hospital Part V, Section B, Line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. Schedule H, Part V, Line 7a and 10a: CHNA:nmhcare.org/wp-content/uploads/2021/01/2020-2023-CHNA-CHIP.pdfImplementation Strategy:nmhcare.org/wp-content/uploads/2021/01/2020-2023-CHNA-CHIP.pdf Schedule H, Part V, Line 16a-c: Financial Assistance Policy:nmhcare.org/about-us/documents Financial Assistance Application:nmhcare.org/about-us/ Financial Assistance Plain Language Summary:nmhcare.org/about-us/ 1 1 - Northern Montana Care Center 24 13th Street Havre MT 59501 Nursing Home Part I, Line 6a: The Organization's community benefit report was published as a 1/2 page ad in the local newspaper. In addition, a statement about the amount of community benefit the organization provided can be found on our web-site at www.nhmcare.org/about-us/documents/. Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid, line 7b, was calculated using the cost-to-charge ratio derived from Worksheet 2. Community health improvement services, line 7e, health professional education, line 7f, and cash and in-kind donations, line 7i, are actual costs reported in the general ledger. The cost for subsidized health services reported on line 7g was determined using the cost-to-charge ratio derived from worksheet 2. Part II, Community Building Activities: Reported under community building activities is the maintenance of our fitness park which is open to the public and has both a softball field and soccer field, as well as a paved walking path. It also includes an employee's time for being a member of the Hill County Health Consortium, which collaboratively conducted a Community Health Needs Assessment with several other local public health entities and works to implement the identified unmet needs of the community. Part III, Line 2: The organization determines its estimate of implicit price concessions based on its historical collection experience with this class of patients and residents. Part III, Line 3: The estimated amount of implicit price concessions attributable to patients eligible under the Organization's charity care policy is calculated by using the percent of population in the Organization's service area below FPG. The Organization feels it is reasonable to assume at least the same percentage of implicit price concessions is attributable to those that would have qualified for charity care, had the Organization had the information available to determine eligibility. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 11 of the attached audited financial statements. Part III, Line 8: Services are provided to patients under the Medicare program knowing that not all costs associated with providing these services will be recovered. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the entire Medicare shortfall is considered a community benefit.Medicare allowable cost is based on the Medicare cost report. The Medicare cost report is completed based on the rules & regulations set forth by Centers for Medicare and Medicaid Services. Part III, Line 9b: The Organization's financial assistance policy provides information on collection practices for those known to qualify for financial assistance. The policy states "During the patient registration or collection process, the Hospital will make an initial determination of eligibility based on verbal or written application for charity care. Pending final eligibility determination, the Hospital will not initiate collection efforts or request for deposits, provided that the responsible party is cooperative with the Hospital's efforts to reach a determination of status." The collection policy currently sends all patients accounts with a private pay balance to a billing service after 120 days. The billing service works directly with the patient to make payment arrangements. If they default on the payment plan the billing service recommends to the hospital to send the account to collections; however if the patient applies for financial assistance within 240 days of the date of the first invoice the hospital pulls the account back from collections and the billing service to review and complete the application process. Part VI, Line 2: In addition to conducting Community Health Needs Assessments, Northern Montana Hospital assesses the needs of the communities it serves in several ways. NMH reviews the top ten diagnosis in it's two Rural Health Clinics at least quarterly. We also monitor "left without being seen" patients in the Emergency Department. We monitor blood pressure and tobacco and alcohol status with every patient visit. We also have a Diabetes Prevention program that meets at least monthly with enrolled patients. In addition, we have a Chronic Care Management program in which our two Care Coordinators monitor high risk patients via phone calls and a software program called Chronic Care IQ that patients in the program interact with and record their vital signs back to NMH regularly. Part VI, Line 3: Northern Montana Hospital informs and educates patients about their eligibility for assistance through a sign posted at our admissions desk, notes in the brochure we give patients at our clinics, and signs posted at our clinic registration desks. In addition, our collection staff offers charity care as an option when they are discussing the patient's balance as well as the availability of various government benefits, such as Medicaid or state programs. NMH has contracted with a company to assist the patient with qualification for programs such as Medicaid and disability determination.We also publish a community benefit report annually which states how much financial assistance we have given away, and we post our community benefit report on our website noting that we provide financial assistance. Part VI, Line 4: The Hospital's service area consists of Hill, Blaine, Liberty, Philips and the Big Sandy census district of Choteau counties. The population of this service area is approximately 30,300. The median household income is about $42,000. Approximately 45% of the population has a household income below 200% of the federal poverty guidelines. Approximately 29% of the population is covered by Medicaid, 35% by Medicare, 2.5% by CHIP and about 14% uninsured. Additionally, another 3% of the population is covered by Indian Health Services. The entire service area is considered rural and has been designated a health professional shortage area for all primary medical care, mental health and dental. In addition, the entire service area is designated as a medically underserved area. Northern Montana Hospital is the only local hospital in its service area; however there are 3 critical access hospitals, 4 rural health clinics, 3 community health clinics and 3 IHS-Tribal clinics within its service area. The nearest hospital is a critical access hospital and is 35 miles away. Part VI, Line 5: More than 50% of Northern Montana Hospital's governing board consists of various local business people who reside within our service area and are not employed or contracted by the organization. Northern Montana Hospital extends medical staff privileges to all qualified physicians in its community. The organization applies surplus funds to improvements in patient care by keeping its medical equipment up to date, sending its employed physicians for further continuing education, supporting nursing education through loan repayment assistance and scholarship programs and supporting health care education through an education assistance program. In addition, the hospital subsidizes its emergency department by offering 24/7 emergent care coverage to all, regardless of their ability to pay. Northern Montana Hospital offers Dialysis services to patients in our service area, despite the fact that this service is provided at a loss to NMH. Without this service, patients would have to travel well over 100 miles each way, 3 times per week to receive this service. Northern Montana Hospital has Sole Community Designation. The nearest PPS hospital is located 110 miles from Havre. Northern Montana Hospital also participates in all government sponsored health programs, such as CHIP, Healthy Montana Kids and the Montana Cervical and Breast Cancer Program, where it accepts payments for services at greatly discounted rates. Several members of Northern Montana Hospital's leadership team serve on other community boards, such as: Havre Chamber of Commerce, Hill County Health Consortium, Local Emergency Planning, Fetal/Infant/Child Mortality Review Board, Havre/Hill County Planning Board, Hill and Blaine County Adult Protective Services Committee, Hill County United Way, HRDC Medical Advisory Board, MSU-N Nursing Advisory Board and the Safe Kids Safe Communities Committee. Part VI, Line 7, Reports Filed With States MT 1 Education Assistance 4 7351 Nursing Scholarships 6 47718 Nurse Loan Repayment 7 32500 Part I, Line 2: The organization provides education assistance to qualified employees. The organization monitors the use of the assistance by disbursing the funds directly to the institution. Schedule I, Part III: The Organization will pay up to $5,250 per person per year for educational assistance in a healthcare related field. Not all recipients request the total amount. The Organization anticipates 3-8 recipients per year. The Organization will pay up to $5,000 per person for nursing scholarships. The Organization anticipates 3-6 per year. The Organization will pay up to $7,500 per person for loan repayments. The Organization anticipates 2-4 per year. 0 0 0 1 0 0 0 0 0 Walter Smith MD Radiologist 630643 0 0 0 1188 0 5700 0 38059 0 675590 0 0 0 Michelle Cameron-Donaldson MD Orthopedic Surgeon 635245 0 0 0 414 0 5700 0 29388 0 670747 0 0 0 Damian Ymzon MD General Surgeon 556741 0 0 0 293 0 5700 0 36901 0 599635 0 0 0 Kevin Harada MD Trustee-IPD Member 494179 0 0 0 176 0 5700 0 35832 0 535887 0 0 0 Karrie Lien MD Secretary 455082 0 0 0 839 0 5700 0 37946 0 499567 0 0 0 Vincent Grant MD General Surgeon 399162 0 0 0 2286 0 5700 0 5061 0 412209 0 0 0 Alexandria Rutherford MD Family Practice 340378 0 0 0 176 0 5700 0 12406 0 358660 0 0 0 Cameron Acor DPM Chief of Medical Staff 253170 0 0 0 449 0 5467 0 35242 0 294328 0 0 0 Gary Grow PhD Trustee - IPD Member 189281 0 0 0 2477 0 3945 0 16252 0 211955 0 0 0 Christen Obresley Vice President 167901 0 0 0 446 0 3498 0 17325 0 189170 0 0 0 Kim Lucke VP of Finance 132293 0 0 0 745 0 2890 0 24451 0 160379 0 0 0 Part I, Line 3 President/CEO is compensated by an unrelated management company. A related organization and the management company have a process in place to determine the CEO's compensation using the Form 990 of other organizations, a written employment contract, a compensation survey or study, and the approval by the board or compensation committee. Part I, Line 5 Karrie Lien, Kevin Harada, J. Gary Grow, and Cameron Acor are compensated as a percentage of the prior three months' average gross revenue earned for the hospital by the physician, with the percentage being based on their speciality. Form 990, Part VI, Section A, line 3 David C. Henry, President/CEO is employed by Fundamental Financial Group, an unrelated management company. Northern Montana Hospital (NMH), pays the unrelated management company for David's services provided to the Hospital, Northern Montana Health Care, Inc. and Northern Montana Health Care Foundation. The President/CEO's responsibilities include implementing decisions and supervising the management, administration and operation of the Hospital and the related, exempt organizations. The amount of compensation paid during fiscal year 2021 was $510,000. The amount of compensation paid during the calendar year 2020 was $493,000. Form 990, Part VI, Section A, line 6 The sole member of the organization is Northern Montana Health Care, Inc. Form 990, Part VI, Section A, line 7b The sole member of the organization shall have such rights and powers as are provided for in the Articles of Incorporation, the Bylaws of the organization and the laws of the State of Montana, including but not limited to, the exclusive power: (a) to remove any trustee from any office at any time, with or without cause; (b) to propose and approve (i) a plan of dissolution or liquidation of the organization or (ii) a plan of merger or consolidation of the organization with another corporation; (c) to propose and approve amendments to the articles of incorporation and or the bylaws;(d) to adopt any annual or long-term capital or operational budget or any changes therein exceeding $75,000;(e) to authorize the organization to enter into any contract or engage in any transaction which is not provided for in an annual or long-term capital or operational budget approved by the sole member of the organization where the amount involved exceeds $50,000;(f) to adopt substantive changes to existing long-term or master institutional plans of the organization; (g) to authorize the organization to engage in, or enter into, any transaction providing for the sale, mortgage or other disposition of all or substantially all of the assets of the organization; (h) to organize or acquire, or authorize the organization or acquisition of, any subsidiary or affiliate of the organization; (i) to authorize the organization to enter into any shared service agreement; (j) to approve long-term borrowing of money by the organization or authorize the organization to incur indebtedness involving a mortgage or lien on assets; or (k) to approve the trustees or the President of the organization from a slate prepared by the Nominating Committee of the organization. Form 990, Part VI, Section A, line 8b No committee has the authority to act on behalf of the board. Form 990, Part VI, Section B, line 11b The VP of Finance reviews the form. The Board of Directors receives a copy of the reviewed Form 990 via e-mail before it is filed. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers all trustees, directors, officers, and key employees. The board identifies potential conflicts from annual disclosures. Disclosures are reviewed by administration after all are gathered. A second conflict disclosure letter is sent out annually to all current and former officers, directors, trustees, and key employees to ensure all potential conflicts are identified. The results of this disclosure form are reviewed by the VP of Finance. The board discusses the potential conflicts and determines if voting on related items would be a conflict of interest. If a conflict is determined to exist, the conflicted individual is excluded from voting on the conflicted item. Form 990, Part VI, Section B, line 15a The President/CEO is compensated by an unrelated management company. The unrelated management company receives a fee for service for the CEO's service provided to this organization and related organizations, Northern Montana Health Care, Inc (NMHC) and Northern Montana Health Care Foundation, Inc. (NMHCF). In determining the CEO's compensation, the governing board, with the exception of the CEO, meets and reviews NMH and NMHC financial results, CEO's current year priorities, discusses evaluation tools to be used for the CEO's evaluation, how comparative salaries will be obtained and discusses the history of compensation to the CEO. At a second meeting the Board reviews non-financial activity of NMH and NMHC and the results of the CEO evaluations completed by the board members. Then they review and discuss a compensation comparative summary of Montana CEO's compensation. They agree upon a list of the coming year's priorities for the CEO and proposed compensation, with the compensation set by board vote. This annual process was completed during fiscal year 2021. The CEO reviews and approves the compensation for all other officers and physicians. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy, and financial statements are made available to the public upon request. The financial statements are attached to the Form 990 per the IRS instructions. Form 990, Part IX, line 11g Healthcare professionals: Program service expenses 6,122,932. Management and general expenses 0. Fundraising expenses 0. Total expenses 6,122,932. Other Fees: Program service expenses 1,807,289. Management and general expenses 1,208,850. Fundraising expenses 0. Total expenses 3,016,139. Form 990, Part XI, line 9: Minimum Pension Liability Adjustment: 4,989,473. Equity Transfer to Affiliate - Northern Montana Health Care, Inc. -500,000. Form 990, Part XII, Line 2c: The controlling organization, Northern Montana Health Care, Inc.'s Board has a committee that assumes responsibility for oversight of the audit of the financial statements and selection of an independent auditor. Northern Montana Health Care Inc PO Box 1231 Havre MT 59501 810428854 Supporting Organization MT 501(c)(3) Line 12b, II N/A 0 Northern Montana Health Care Foundation Inc PO Box 1231 Havre MT 59501 363464641 Fundraising MT 501(c)(3) Line 7 Northern Montana Health Care Inc 0 0 0 1 0 0 0 0 0 0 0 1 1 0 1 1 0 1 0 1