CULBERTSON FROID BAINVILLE HEALTH CARE CORPORATION: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- CULBERTSON FROID BAINVILLE HEALTH CARE CORPORATION (EIN 81-0373589)
- Tax period
- 2019-05-01 to 2020-04-30
- Filed
- 2021-03-02
- IRS object ID
- 202110619349301411
- Schema version
- 2019v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-03-02T12:04:46-06:00 | ReturnTs |
| Tax Period End | 2020-04-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREEN HEALTH GROUP PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 5TH ST S SUITE 106 | AddressLine1Txt |
| City | GLASGOW | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 592302338 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-05-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810373589 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULBERTSON FROID BAINVILLE | BusinessNameLine1Txt |
| Business Name Line2 | HEALTHCARE CORPORATION | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CULB | BusinessNameControlTxt |
| Phone | 4067876401 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 419 | AddressLine1Txt |
| City | CULBERTSON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59218 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | AUDREY STROMBERG | PersonNm |
| Person Title | ADMINISTRATOR | PersonTitleTxt |
| Phone | 4067876401 | PhoneNum |
| Signature | 2021-02-24 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DANIEL GREEN | PreparerPersonNm |
| PTIN | P01311679 | PTIN |
| Phone | 4062632615 | PhoneNum |
| Preparation | 2021-03-02 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROOSEVELT MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | AUDREY STROMBERG | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 419 | AddressLine1Txt |
| City | CULBERTSON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59218 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $6,129,156 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | ROOSEVELTMEDICAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1976 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | ROOSEVELT MEDICAL CENTER IS DEDICATED TO PROVIDING PATIENTS WITH APPROPRIATE, PERSONALIZED, AND QUALITY HEALTH CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 95 | TotalEmployeeCnt |
| Total Volunteers | 30 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $712,331 | PYContributionsGrantsAmt |
| CY Contributions Grants | $142,719 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $5,604,315 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $5,699,367 | CYProgramServiceRevenueAmt |
| PY Investment Income | $35,214 | PYInvestmentIncomeAmt |
| CY Investment Income | $14,317 | CYInvestmentIncomeAmt |
| PY Other Revenue | $287,345 | PYOtherRevenueAmt |
| CY Other Revenue | $272,753 | CYOtherRevenueAmt |
| PY Total Revenue | $6,639,205 | PYTotalRevenueAmt |
| CY Total Revenue | $6,129,156 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $3,577,982 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,606,097 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $41,182 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,360,225 | PYOtherExpensesAmt |
| CY Other Expenses | $2,562,027 | CYOtherExpensesAmt |
| PY Total Expenses | $5,938,207 | PYTotalExpensesAmt |
| CY Total Expenses | $6,168,124 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $700,998 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$38,968 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,206,697 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,414,285 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $923,787 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,170,343 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,282,910 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,243,942 | NetAssetsOrFundBalancesEOYAmt |
| Mission | ROOSEVELT MEDICAL CENTER IS DEDICATED TO PROVIDING PATIENTS WITH APPROPRIATE, PERSONALIZED, AND QUALITY HEALTH CARE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $5,030,580 | ExpenseAmt |
| Revenue | $5,699,367 | RevenueAmt |
| Desc | ROOSEVELT MEDICAL CENTER IS DEDICATED TO PROVIDING PATIENTS WITH APPROPRIATE, PERSONALIZED, AND QUALITY HEALTH CARE. | Desc |
| Total Program Service Expenses | $5,030,580 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 15 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 95 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JENNIFER KESSNER | PersonNm |
| Phone | 4067876401 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 419 | AddressLine1Txt |
| City | CULBERTSON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59218 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| DON HELLAND | |||||||
| MD | 40.00 | Yes (X) | $202,939 | $0 | $6,381 | ||
| ELIZABETH KLEPPEN | |||||||
| PA-C | 24.00 | Yes (X) | $196,372 | $0 | $4,015 | ||
| ZOE FUGERE | |||||||
| FNP-C | 40.00 | Yes (X) | $144,580 | $0 | $6,381 | ||
| DANIELLE CHRISTENSEN | |||||||
| RN | 58.00 | Yes (X) | $136,626 | $0 | $6 | ||
| JENNIFER KESSNER | |||||||
| CFO | 44.00 | $108,723 | $0 | $6,381 | Yes (X) | ||
| AUDREY STROMBERG | |||||||
| ADMINISTRATO | 40.00 | $97,952 | $0 | $6 | Yes (X) | ||
| PAM ARNESON | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| BRIDGETTE FEATHERSTON | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| KEN FORBREGD | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| KEVIN MILLER | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| JO NELSON | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| CHANON ROMO | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| GRANT SALVEVOLD | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| PAULA SCHLEDEWITZ | |||||||
| CHAIRMAN | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| SHARON SCHMITZ | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $887,192 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $23,170 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| HEALTHCARE SERVICES GROUP INC | |||||
| 3220 TILLMAN DRIVE SUITE 300 | BENSALEM | PA | 19020 | DIETARY SVCS | $311,285 |
| MONTANA HEALTH NETWORK INC | |||||
| 519 PLEASANT STREET | MILES CITY | MT | 59301 | NURSING STAFF | $247,573 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $37,036 | RelatedOrganizationsAmt |
| Government Grants | $19,318 | GovernmentGrantsAmt |
| All Other Contributions | $86,365 | AllOtherContributionsAmt |
| Total Contributions | $142,719 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT REVENUE | 621500 | $5,438,631 | $5,438,631 |
| MISC REVENUE | 900099 | $260,736 | $260,736 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $5,699,367 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,317 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,317 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| HOSPITAL DISTRICT SUBSIDY | 900099 | $272,003 | $272,003 |
| GAIN ON DISPOSAL OF ASSETS | 900099 | $750 | $750 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $272,753 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,129,156 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,986,437 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $221,727 | TotalAmt |
| Management And General | $221,727 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,920,318 | TotalAmt |
| Program Services | $2,512,931 | ProgramServicesAmt |
| Management And General | $373,991 | ManagementAndGeneralAmt |
| Fundraising | $33,396 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,953 | TotalAmt |
| Program Services | $10,356 | ProgramServicesAmt |
| Management And General | $2,460 | ManagementAndGeneralAmt |
| Fundraising | $137 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $182,193 | TotalAmt |
| Program Services | $141,576 | ProgramServicesAmt |
| Management And General | $38,746 | ManagementAndGeneralAmt |
| Fundraising | $1,871 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $268,906 | TotalAmt |
| Program Services | $212,493 | ProgramServicesAmt |
| Management And General | $53,329 | ManagementAndGeneralAmt |
| Fundraising | $3,084 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,338,882 | TotalAmt |
| Program Services | $1,198,429 | ProgramServicesAmt |
| Management And General | $140,443 | ManagementAndGeneralAmt |
| Fundraising | $10 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,353 | TotalAmt |
| Management And General | $8,353 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $256,040 | TotalAmt |
| Program Services | $176,109 | ProgramServicesAmt |
| Management And General | $78,942 | ManagementAndGeneralAmt |
| Fundraising | $989 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $817 | TotalAmt |
| Program Services | $817 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,929 | TotalAmt |
| Program Services | $56,452 | ProgramServicesAmt |
| Management And General | $15,311 | ManagementAndGeneralAmt |
| Fundraising | $166 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,135 | TotalAmt |
| Program Services | $4,102 | ProgramServicesAmt |
| Management And General | $1,007 | ManagementAndGeneralAmt |
| Fundraising | $26 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,714 | TotalAmt |
| Program Services | $81,178 | ProgramServicesAmt |
| Management And General | $20,017 | ManagementAndGeneralAmt |
| Fundraising | $519 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $114,567 | TotalAmt |
| Program Services | $91,436 | ProgramServicesAmt |
| Management And General | $22,547 | ManagementAndGeneralAmt |
| Fundraising | $584 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| REPAIRS & MAINTENANCE | $321,962 | $233,976 | $87,602 | $384 |
| MEDICAL SUPPLIES | $282,446 | $282,446 | ||
| BED TAX | $27,539 | $27,539 | ||
| MISC | $25,346 | $23,038 | $2,292 | $16 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,297 | TotalAmt |
| Program Services | $5,241 | ProgramServicesAmt |
| Management And General | $2,056 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,168,124 | TotalAmt |
| Program Services | $5,030,580 | ProgramServicesAmt |
| Management And General | $1,096,362 | ManagementAndGeneralAmt |
| Fundraising | $41,182 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,987 | BOYAmt |
| EOY | $1,647 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,125,358 | BOYAmt |
| EOY | $2,854,126 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $97,273 | BOYAmt |
| EOY | $130,276 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,158,100 | BOYAmt |
| EOY | $1,056,407 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $122,773 | BOYAmt |
| EOY | $167,648 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $71,296 | BOYAmt |
| EOY | $73,515 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,110,670 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,162,774 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $452,508 | BOYAmt |
| EOY | $947,896 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $175,402 | BOYAmt |
| EOY | $182,770 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,206,697 | BOYAmt |
| EOY | $5,414,285 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $746,061 | BOYAmt |
| EOY | $859,850 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $85,387 | BOYAmt |
| EOY | $44,435 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $653,900 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,339 | BOYAmt |
| EOY | $1,612,158 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $923,787 | BOYAmt |
| EOY | $3,170,343 | 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 | $1,759,889 | BOYAmt |
| EOY | $2,214,309 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $523,021 | BOYAmt |
| EOY | $29,633 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,282,910 | BOYAmt |
| EOY | $2,243,942 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,206,697 | BOYAmt |
| EOY | $5,414,285 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$38,968 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $366 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $366 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART IV | FormAndLineReferenceDesc |
| Explanation | 1.61 PERCENT OF DUES PAID TO MHA AND 23.32 PERCENT OF DUES PAID TO AHA, WHICH TOTALED 366, WERE USED FOR LOBBYING EXPENSES BY MHA. | ExplanationTxt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,328,071 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,972,740 | DepreciationAmt |
| Book Value | $355,331 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,782,599 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,190,034 | DepreciationAmt |
| Book Value | $592,565 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $947,896 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| MEDICARE/MEDICAID ESTIMATED PAYABLE | $1,369,564 |
| REFUND ADVANCE-PROVIDER RELIEF FUNDS | $131,607 |
| RESIDENT DEPOSITS PAYABLE | $110,987 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,612,158 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $6,129,156 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $6,129,156 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $6,129,156 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $6,168,124 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $6,168,124 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $6,168,124 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 3, PART X | FormAndLineReferenceDesc |
| Explanation | IT IS THE JUDGEMENT OF MANAGEMENT THAT THE COMPANY HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,704 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $23,704 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00380 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,704 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $23,704 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00380 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $148,414 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,405 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $129,009 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02090 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,435,975 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,163,967 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $272,008 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04410 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,584,389 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,183,372 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $401,017 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06500 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,608,093 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,183,372 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $424,721 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06890 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $79,429 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $2,242,765 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $2,289,477 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$46,712 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | 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 | ROOSEVELT MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 419 | AddressLine1Txt |
| City | CULBERTSON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59218 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROOSEVELT MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 17 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | ROOSEVELTMEDICAL.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 17 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | ROOSEVELTMEDICAL.ORG | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | 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 (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.ROOSEVELTMEDICAL.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.ROOSEVELTMEDICAL.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.ROOSEVELTMEDICAL.ORG | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, ROOSEVELT MEDICAL CENTER - PART V, LINE 3E | THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND ARE IDENTIFIED THROUGH THE CHNA. |
| FACILITY 1, ROOSEVELT MEDICAL CENTER - PART V, LINE 5 | IN MARCH 2017, A STEERING COMMITTEE WAS CONVENED TO ASSIST ROOSEVELT MEDICAL CENTER IN CONDUCTING THE CHNA. THE COMMITTEE WAS A DIVERSE GROUP OF MEMBERS WHICH REPRESENTED VARIOUS ORGANIZATIONS AND POPULATIONS WITHIN THE COMMUNITY SUCH AS PUBLIC HEALTH, MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY CITIZENS, SENIORS, YOUTH, AND TRIBAL/AMERICAN INDIANS. IN AUGUST 2017, KEY INFORMANT INTERVIEWS WERE CONDUCTED BY A REPRESENTATIVE WITH THE MONTANA OFFICE OF RURAL HEALTH. ALSO, IN OCTOBER 2017, A SURVEY WAS MAILED TO 800 RANDOMLY SELECTED RESIDENTS IN THE HOSPITAL'S SERVICE AREA TO SOLICIT THEIR INPUT. THERE WAS A 20.5 PERCENT RESPONSE. |
| FACILITY 1, ROOSEVELT MEDICAL CENTER - PART V, LINE 11 | THE PRIORITIZED HEALTH NEEDS AS DETERMINED THROUGH THE ASSESSMENT PROCESS AND WHICH THE FACILITY WILL BE ADDRESSING RELATES TO THE FOLLOWING HEALTHCARE ISSUES: 1. SENIOR SERVICES 2. HEALTH AND WELLNESS 3. ALCOHOL AND SUBSTANCE ABUSE THE FIRST HEALTHCARE ISSUE IS TO ENHANCE SENIOR SERVICES AVAILABLE IN ROOSEVELT COUNTY. ONE STRATEGY FOR ADDRESSING THIS ISSUE IS TO INCREASE THE AVAILABILITY OF HEALTH SERVICES FOR ROOSEVELT COUNTY SENIORS SUCH AS EXPLORING THE FEASIBILITY OF OFFERING A HEALTH CLINIC SUCH AS FOOT CARE, BLOOD PRESSURE CHECK, FINGER POKE BLOOD GLUCOSE CHECK, COORDINATING WITH THE SENIOR CENTER TO OFFER ACTIVITIES REGARDING VARIOUS HEALTH TOPICS, AND DEVELOPING PROTOCOL FOR REFERRING PATIENTS TO THE CLINIC. THE SECOND STRATEGY IS TO INCREASE ACCESS TO SENIOR SERVICES THROUGH ENHANCED MARKETING STRATEGIES SUCH AS DEVELOPING MARKETING AND OUTREACH MATERIALS TO NOTIFY SENIORS OF SERVICES AND NEW PROGRAMS AVAILABLE, CREATING AN EDUCATIONAL FLYER FOR INFORMATION RELATED TO MEDICARE WELLNESS CHECKS, AND DEVELOPING AN EDUCATION PRESENTATION TO ASSIST SENIORS WITH MEDICARE ENROLLMENT OR OTHER COVERAGE. RMC HAS MADE AN EFFORT TO EVALUATE MEDICARE PATIENTS AND ENROLL PATIENTS IN MEDICARE'S CHRONIC CARE MANAGEMENT (IF APPLICABLE). RMC HAD STAFF ATTEND LUNCH-AND-LEARNS DURING SENIOR MEALS DOWNTOWN WHERE THEY PROVIDED INFORMATION ABOUT SENIOR HEALTH AS WELL AS PROVIDED QUESTION-AND-ANSWER SESSIONS ABOUT INSURANCE COVERAGE, MEDICARE, AND OTHER HEALTH RELATED TOPICS AND CONCERNS UNTIL COVID-19. RMC CONTINUES TO GET INFORMATION OUT TO THE PUBLIC BY UTILIZING LOCAL BUSINESSES SUCH AS THE POST OFFICE WHERE THEY LEAVE INFORMATION AND GIVEAWAYS THAT CAN BE EASILY ACCESSED. RMC HAS ALSO LAUNCHED MARKETING CAMPAIGNS ABOUT THE BENEFITS OF AN ANNUAL WELLNESS VISIT AND OTHER SENIOR RELATED HEALTH TOPICS. THE SECOND HEALTHCARE ISSUE IS TO IMPROVE ACCESS TO HEALTH AND WELLNESS PROGRAMS AND EVENTS IN ROOSEVELT COUNTY. ONE STRATEGY FOR ADDRESSING THIS ISSUE IS TO EXPLORE NEW PARTNERSHIPS, PROGRAMS, AND ACTIVITIES THAT WILL INCREASE OPPORTUNITIES TO STAY PHYSICALLY ACTIVE IN ROOSEVELT COUNTY SUCH AS UTILIZING RMC'S PHYSICAL THERAPY ROOM AS A WORKOUT FACILITY OPEN TO THE PUBLIC, CONTINUING TO PARTICIPATE IN AND PROMOTING SHAPE UP MONTANA FOR EMPLOYEES AND CHALLENGE GROUPS AND PROMOTING THE HEALTH LIFESTYLES PROGRAM AT THE HOSPITAL, EXPLORING OFFERING A 5K FUN RUN/WALK IN THE COMMUNITY AND A TRAILS RX/PRESCRIPTION WALKING PROGRAM TO IMPLEMENT IN THE CLINIC. THE SECOND STRATEGY IS TO INCREASE ACCESS TO HEALTH AND WELLNESS PROGRAMS AND RESOURCES THROUGH MARKETING STRATEGIES INCLUDING PROVIDING YEAR-END PACKAGES FOR STUDENTS, HEART HEALTH MONTH, ETC., CONTINUING TO SUPPORT EVENTS SUCH AS THE COLOR RUN (BREAST CANCER AWARENESS EVENT), EXPLORING DEVELOPING AND DISSEMINATING A FREE IN-CASE OF EMERGENCY MAGNET AND ADVERTISING ON WEBSITE/HEALTH FAIR/SOCIAL MEDIA. OTHER ACTIVITIES FOR THE SECOND STRATEGY MAY INCLUDE PUBLISHING A HOSPITAL NEWSLETTER TWICE A YEAR TO BE MAILED TO ALL PO BOX HOLDERS IN THE RMC SERVICE AREA, SENDING OUT MONTHLY HEALTH UPDATE E-MAILS TO THE HOSPITAL LISTSERV, AND PARTNERING WITH THE RURAL HEALTH INITIATIVE AND SHARING THEIR EDUCATIONAL WEBINARS AND RESOURCES WITHIN THE COMMUNITY. RMC PROVIDES A NUMBER OF EDUCATIONAL EMAILS, SOCIAL MEDIA, DIRECT MAILINGS AND IN-PERSON CAMPAIGNS TO PROMOTE HEALTH AND WELLNESS THAT COVER A WIDE VARIETY OF TOPICS RELATED TO HEALTH CONCERNS SUCH AS HEART HEALTH, CANCER, ALCOHOL CONSUMPTION, DIABETES, ETC. EVERY MONTH THERE IS A FEATURED HEALTH ISSUE RMC PROVIDES AWARENESS FOR WHILE ADDRESSING OTHER TIMELY HEALTH CONCERNS THAT ARISE, SUCH AS THE CORONAVIRUS. THE THIRD HEALTHCARE ISSUE IS TO IMPROVE OUTREACH AND EDUCATION EFFORTS REGARDING ALCOHOL AND SUBSTANCE ABUSE. THE STRATEGY FOR ADDRESSING THIS ISSUE IS TO UTILIZE EDUCATION, PROGRAMS, AND EVENTS TO ENHANCE COMMUNITY KNOWLEDGE ABOUT ALCOHOL/SUBSTANCE ABUSE PREVENTION AND RESOURCES SUCH AS PARTICIPATING IN THE NATIONAL PRESCRIPTION DRUG TAKE BACK DAY, WORKING WITH COMMUNITY PARTNERS TO CREATE A MEDIA CAMPAIGN, AND DEVELOPING AN ALCOHOL AND SUBSTANCE ABUSE EDUCATION PROGRAM IN PARTNERSHIP WITH LOCAL SCHOOLS, EMS AND LAW ENFORCEMENT. OTHER ACTIVITIES MAY INCLUDE SENDING STAFF TO BECOME CERTIFIED AS A "MASTER TRAINER" TO PROVIDE COMMUNITY EDUCATION ON OPIOID OVERDOSE AND USE OF NALOXONE, AND CONTINUING DISSEMINATING THE DRUG AND ALCOHOL RESOURCE LIST THROUGHOUT THE CLINIC AND COMMUNITY. RMC ENGAGES IN OUTREACH ACTIVITIES THAT INCLUDED A MONTH-LONG ALCOHOL AWARENESS CAMPAIGN, PROVIDES ANNUAL END-OF-YEAR INFORMATION BAGS THAT PROMOTES GENERAL HEALTH AND WELLNESS, GOOD CHOICES, AND INCLUDES EDUCATIONAL MATERIALS ABOUT VAPING, ALCOHOL, AND DRUG ABUSE THAT WENT TO THE SCHOOLS, AND PARTICIPATED IN AN UNUSED PRESCRIPTION TAKE-BACK DAY WITH THE PHARMACY. RMC WAS ABLE TO SECURE A BEHAVIORAL HEALTH GRANT TO PURCHASE ALL OF THE ITEMS FOR THE INFORMATION BAGS. DUE TO LOW STAFFING AND COVID-19, THE MORE ROBUST PROGRAM THAT WAS ORIGINALLY PLANNED FOR THE ALCOHOL AND SUBSTANCE ABUSE HEALTH ISSUE CANNOT BE DONE. THREE HEALTH NEEDS WERE IDENTIFIED THAT WERE UNABLE TO BE ADDRESSED BY RMC. FIRST, RESPONDENTS FELT MORE PRIMARY CARE PROVIDERS WOULD IMPROVE THE COMMUNITY'S ACCESS TO HEALTHCARE. RMC IS CONTINUALLY WORKING TO EXPAND ITS PRIMARY CARE SERVICES. WORKFORCE SHORTAGES AND THE REMOTE LOCATION OF CULBERTSON CREATES A UNIQUE AND CHALLENGING ENVIRONMENT FOR PROVIDER RECRUITMENT. SECOND, RESPONDENTS FELT MORE SPECIALISTS WOULD IMPROVE THE COMMUNITY'S ACCESS TO HEALTHCARE. RMC INDICATES THAT PROVIDING FULL-TIME SPECIALISTS IS BEYOND THE RESOURCE CAPACITY OF THE ORGANIZATION AND IS DIFFICULT DUE TO REMOTE LOCATION. RMC DOES HAVE SPECIALISTS THAT ROTATE THROUGH ON A PERIODIC BASIS. THIRD, OTHER MEDICAL SERVICES SUCH AS DENTAL CARE AND MASSAGE THERAPY WERE REQUESTED. RMC INDICATES THAT PROVIDING THESE SERVICES IS CURRENTLY BEYOND THE RESOURCE AND FINANCIAL CAPACITY OF RMC AT THIS TIME. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROOSEVELT MEDICAL CENTER CLINIC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 818 2ND AVE E | AddressLine1Txt |
| City | CULBERTSON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59218 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | RURAL HEALTH CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 7G | PHYSICIAN PROFESSIONAL SERVICES MAKE UP 124,905 OF COLUMN C, 76,513 OF COLUMN D, AND 48,393 OF COLUMN E. THE COST OF BAD DEBT REMOVED FROM THE COMMUNITY BENEFIT EXPENSE IN COLUMN C IS 51,361. ROOSEVELT MEDICAL CENTER'S EFFORTS TO RECRUIT AND RETAIN PHYSICIANS AND OTHER PROVIDERS ARE DEPENDENT ON OUR ABILITY TO COMPETE WITH ALL OTHER COMMUNITIES THAT ARE RECRUITING SIMILAR PHYSICIANS AND PROVIDERS. BECAUSE OF OUR SMALL COMMUNITY SIZE AND REMOTE LOCATION FAR REMOVED FROM MEDICAL COMMUNITIES OF GREATER SCOPE, WE EMPLOY PHYSICIANS AND SUBSIDIZE PHYSICIAN PRACTICES TO OFFER APPROPRIATELY COMPETITIVE SALARIES AND PRACTICE ENVIRONMENTS (SPECIFICALLY, REASONABLE CALL SCHEDULES). WE BELIEVE OUR ABILITY TO OFFER CORE NECESSARY PRIMARY CARE AND EMERGENCY SERVICES IS DEPENDENT ON SUBSIDIZATION. |
| SCHEDULE H, PART I, LINE 7 | USED ADJUSTED COST TO CHARGE RATIOS FOR PATIENT CARE FROM THE MEDICARE COST REPORT, ADJUSTED FOR BED TAX AND COMMUNITY BENEFIT. BAD DEBT EXPENSE AND FINANCIAL ASSISTANCE ARE ALREADY EXCLUDED FROM THE MEDICARE COST REPORT. |
| SCHEDULE H, PART III, LINE 2 | THE ORGANIZATION'S PATIENT CARE COST TO CHARGE RATIO, AFTER ELIMINATING BAD DEBT, FINANCIAL ASSISTANCE, BED TAX, AND COMMUNITY BENEFIT EXPENSE, IS APPLIED TO GROSS BAD DEBT CHARGES TO ARRIVE AT THE COST OF BAD DEBT. DISCOUNTS REDUCE REVENUE AND ARE NOT RECORDED AS BAD DEBT. PAYMENTS RECEIVED ON PREVIOUSLY WRITTEN OFF ACCOUNTS ARE RECORDED AS RECOVERIES OF BAD DEBT WHICH REDUCE BAD DEBT EXPENSE. NONE OF THE BAD DEBT IS CONSIDERED ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE. BAD DEBTS ARE AN INEVITABLE RESULT OF OPERATING A NON PROFIT HOSPITAL. |
| SCHEDULE H, PART III, LINE 4 | THE BAD DEBT EXPENSE FOOTNOTE IS ON PAGE 9 OF THE AUDITED FINANCIAL STATEMENTS. |
| SCHEDULE H, PART III, LINE 8 | THERE IS A MEDICARE SHORTFALL SINCE CRITICAL ACCESS HOSPITALS ARE REIMBURSED 101 PERCENT OF COST FROM MEDICARE FOR MOST SERVICES, LESS THE 2% SEQUESTRATION ADJUSTMENT, AND SOME SERVICES LIKE AMBULANCE ARE PAID BASED ON FEE SCHEDULES. MEDICARE COSTS ON PART III, LINE 6 ARE DIRECTLY FROM THE MEDICARE COST REPORT. MEDICARE REVENUE ON PART III, LINE 5 IS DIRECTLY FROM THE MEDICARE COST REPORT AND THE MEDICARE PROVIDER SUMMARY REPORT. |
| SCHEDULE H, PART III, LINE 9B | IF APPROVED FOR FINANCIAL ASSISTANCE UNDER THE PROVISIONS OF THE FINANCIAL ASSISTANCE POLICY (FAP), THE PATIENT WILL RECEIVE NOTIFICATIONS THAT INCLUDE: A. THE DISCOUNT OF GROSS CHARGES TO THE AGB. THEN FINANCIAL ASSISTANCE DISCOUNTS WILL BE APPLIED TO THE AGB IN ACCORDANCE WITH THE DISCOUNT OF AGB CHARGES SCHEDULE DESCRIBED IN THE "DISCOUNT" SECTION OF THE FAP. B. PROVIDING THE PATIENT WITH A BILLING STATEMENT THAT INDICATES THE AMOUNT THE PATIENT OWES, IF THEY ARE NOT ELIGIBLE FOR FREE CARE. C. REFUNDING ANY EXCESS PAYMENTS MADE BY THE INDIVIDUAL BEYOND THE AGB ON ELIGIBLE ACCOUNTS IF NECESSARY. D. TAKING ALL REASONABLY AVAILABLE MEASURES TO REVERSE EXTRAORDINARY COLLECTION ACTIONS THAT OCCURRED. |
| SCHEDULE H, PART VI, LINE 2 | WE SEND OUT PATIENT SATISFACTION SURVEYS TO OUR PATIENTS. |
| SCHEDULE H, PART VI, LINE 3 | RMC WILL MAKE ALL REASONABLE EFFORTS TO NOTIFY A PATIENT REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THIS POLICY BY: 1. ATTEMPTING TO DETERMINE WHETHER A PATIENT HAS THIRD-PARTY COVERAGE FOR ANY PART OF THE EMERGENCY OR MEDICALLY NECESSARY HEALTH CARE SERVICE PROVIDED. IF A PATIENT DOES NOT HAVE OR QUALIFY FOR THIRD-PARTY FUNDING, THE BUSINESS OFFICE STAFF WILL EXPLAIN THE FINANCIAL ASSISTANCE POLICY, PROVIDE AN APPLICATION FOR FINANCIAL ASSISTANCE AND PROVIDE ASSISTANCE WITH COMPLETING THE APPLICATION, IF DESIRED. 2. OFFERING THE PATIENT A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE AVAILABLE UNDER THIS POLICY AT THE TIME OF ADMISSION OR BEFORE DISCHARGE FROM RMC. 3. PROVIDING THE INFORMATION DURING THE NOTIFICATION PERIOD ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE ON AT LEAST THREE (3) BILLING STATEMENTS AND IN ALL OTHER WRITTEN COMMUNICATIONS IN REFERENCE TO FINANCIAL RECORDS TO THE PATIENT; 4. INFORMING PATIENTS DURING THE NOTIFICATION PERIOD ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE DURING ORAL COMMUNICATIONS REGARDING THE AMOUNT DUE FOR THE CARE THAT OCCURRED; 5. PROVIDING THE PATIENT WITH AT LEAST ONE WRITTEN NOTICE INFORMING THE PATIENT ABOUT THE EXTRAORDINARY COLLECTION ACTIONS THAT RMC MAY TAKE IF THE PATIENT DOES NOT SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE OR PAY THE AMOUNT DUE BY AT LEAST THIRTY DAYS FOLLOWING THE DATE OF THE NOTICE. THE NOTICE WILL NOT BE MAILED OR DELIVERED TO A PATIENT EARLIER THAN 30 DAYS PRIOR TO THE END OF THE NOTIFICATION PERIOD; AND 6. RMC WILL NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS AGAINST A PATIENT UNTIL SUCH TIME AS IT DETERMINES THE PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER THIS POLICY DURING THE 120 DAY NOTIFICATION PERIOD AND HAS PROVIDED THE PATIENT WITH THE NOTICE AS DESCRIBED ABOVE. |
| SCHEDULE H, PART VI, LINE 4 | WE PROVIDE SERVICE TO THE POPULATION IN EASTERN ROOSEVELT COUNTY, SOUTHERN SHERIDAN COUNTY, AND NORTHERN RICHLAND COUNTY. |
| SCHEDULE H, PART VI, LINE 5 | THE ADMINISTRATOR AND MARKETING DIRECTOR OF ROOSEVELT MEDICAL CENTER PARTICIPATE IN THE LOCAL CHAMBER OF COMMERCE. THE MARKETING DIRECTOR WRITES ARTICLES FOR THE LOCAL NEWSPAPER TO PROMOTE THE FACILITY AND DOES PUBLIC SERVICE ANNOUNCEMENTS THROUGH PRINTED MEDIA AND SOCIAL MEDIA (FACEBOOK). |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|
| DON HELLAND | ||||
| MD | $202,939 | $300 | $6,081 | $209,320 |
| ELIZABETH KLEPPEN | ||||
| PA-C | $196,372 | $300 | $3,715 | $200,387 |
| ZOE FUGERE | ||||
| FNP-C | $144,580 | $300 | $6,081 | $150,961 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 2 | PAULA SCHLEDEWITZ GRANT SALVEVOLD CHAIRMAN DIRECTOR FAMILY RELATIONSHIP |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 IS REVIEWED BY THE ADMINISTRATOR, CFO, AND BOARD OF DIRECTORS BEFORE IT IS FILED. |
| FORM 990, PAGE 6, PART VI, LINE 12C | COMPLIANCE IS REVIEWED ANNUALLY. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE ADMINISTRATOR'S COMPENSATION IS APPROVED BY THE BOARD OF DIRECTORS WHICH IS USUALLY BASED ON THE AMOUNT/PERCENTAGE OF RAISE THE REST OF THE EMPLOYEES ARE GOING TO RECEIVE. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE CFO COMPILES INFORMATION FROM THE ANNUAL MHA SALARY SURVEY REGARDING AVERAGE WAGE BEING PAID FOR EACH JOB DESCRIPTION BASED ON PEER GROUP, CRITICAL ACCESS HOSPITALS, OR MHA REGION. THE CFO AND ADMINISTRATOR COMPARE AVERAGES BEING PAID TO THE CURRENT ROOSEVELT MEDICAL CENTER SALARY SCALE TO SEE IF ADJUSTMENTS NEED TO BE MADE TO KEEP EACH JOB COMPETITIVE WITHIN THE INDUSTRY. RECOMMENDATIONS FOR SALARY INCREASES ARE MADE TO THE BOARD OF DIRECTORS FOR APPROVAL OR DISAPPROVAL WHICH IS RECORDED IN THE BOARD MINUTES. |
| FORM 990, PAGE 6, PART VI, LINE 19 | DOCUMENTS RELATING TO ROOSEVELT MEDICAL CENTER ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | ADMIN PROF FEES 0 52,552 0 ADMIN PURCHASED SERVICES 0 15,120 0 CLINIC PROF FEES 16,110 0 0 DIETARY PURCHASED SERVICES 293,319 47,353 0 LAB PROF FEES 1,800 0 0 LAB PURCHASED SERVICES 36,699 0 0 MAINT PURCHASED SERVICES 1,510 372 10 MEDICAL & SURGICAL PROF FEES 184,785 0 0 MEDICAL & SURGICAL PURCH SVCS 3,055 0 0 MEDICAL RECORDS PURCH SRVCS 0 14,548 0 OT PURCHASED SERVICES 20,587 0 0 PT PURCHASED SERVICES 63,053 0 0 AMBULANCE PURCHASED SERVICES 867 0 0 RADIOLOLGY PURCHASED SERVICES 13,344 0 0 SWING BED PROF FEES 516,004 0 0 BUSINESS OFFICE PROF FEES 0 10,318 0 PHARMACY PURCHASED SVCS 46,196 0 0 ER PROF FEES 600 0 0 SWING BED PURCHASED SVCS 500 0 0 BUSINESS OFFICE PURCH SVCS 0 180 0 TOTAL 1,198,429 140,443 10 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Business Name Line2DirectControllingEntityName/BusinessNameLine2Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROOSEVELT MEMORIAL HEALTHCARE FOUND | ||||||||||||
| PO BOX 419 | CULBERTSON | MT | 59218 | 810529284 | SUPPORT OR | MT | 501C3 | 7 | N/A | false | ||
| NE MT STAT AIR AMB COOP | ||||||||||||
| 519 PLEASANT STREET | MILES CITY | MT | 59301 | 204748673 | AIR AMBUL | MT | 501C3 | 12B | false | NA | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| ROOSEVELT MEMORIAL HEALTHCARE FOUND | ||
| C | $37,036 | SUPPORT |
| ROOSEVELT MEMORIAL HEALTHCARE FOUND | ||
| O | $38,488 | PAYROLL |
| ROOSEVELT MEMORIAL HEALTHCARE FOUND | ||
| N | $2,694 | OCCUPANCY |