POWELL COUNTY MEMORIAL HOSPITAL ASSOCIATION: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- POWELL COUNTY MEMORIAL HOSPITAL ASSOCIATION (EIN 81-0469886)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2021-03-11
- IRS object ID
- 202110709349300736
- Schema version
- 2019v5.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-03-11T12:14:38-06:00 | ReturnTs |
| Tax Period End | 2020-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 EAST FRONT STREET 301 | AddressLine1Txt |
| City | MISSOULA | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59802 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810469886 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL COUNTY MEMORIAL HOSPITAL ASSOC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | POWE | BusinessNameControlTxt |
| Phone | 4068462212 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 HOLLENBACK LANE | AddressLine1Txt |
| City | DEER LODGE | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59722 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TONY PFAFF | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 4068462212 | PhoneNum |
| Signature | 2021-03-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | PHILIP L YASENAK CPA | PreparerPersonNm |
| PTIN | P01248379 | PTIN |
| Phone | 4067281800 | PhoneNum |
| Preparation | 2021-03-11 | 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 | DEER LODGE MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TONY PFAFF | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 HOLLENBACK LANE | AddressLine1Txt |
| City | DEER LODGE | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $21,235,397 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | DLMED.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1991 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION OF THE HOSPITAL IS TO PROVIDE HIGH QUALITY HEALTHCARE TO ALL THEY SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 156 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $139,410 | PYContributionsGrantsAmt |
| CY Contributions Grants | $112,735 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $15,405,988 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $19,412,161 | CYProgramServiceRevenueAmt |
| PY Investment Income | $104,286 | PYInvestmentIncomeAmt |
| CY Investment Income | $104,689 | CYInvestmentIncomeAmt |
| PY Other Revenue | $336,475 | PYOtherRevenueAmt |
| CY Other Revenue | $444,290 | CYOtherRevenueAmt |
| PY Total Revenue | $15,986,159 | PYTotalRevenueAmt |
| CY Total Revenue | $20,073,875 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,069,676 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,784,822 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,545,712 | PYOtherExpensesAmt |
| CY Other Expenses | $7,594,145 | CYOtherExpensesAmt |
| PY Total Expenses | $14,615,388 | PYTotalExpensesAmt |
| CY Total Expenses | $17,378,967 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,370,771 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,694,908 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $26,733,441 | TotalAssetsBOYAmt |
| Total Assets EOY | $34,097,729 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $17,376,335 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $21,989,237 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,357,106 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $12,108,492 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF THE HOSPITAL IS TO PROVIDE HIGH QUALITY HEALTHCARE TO ALL THEY SERVE. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $15,109,939 | ExpenseAmt |
| Revenue | $19,823,321 | RevenueAmt |
| Desc | THE HOSPITAL PROVIDES DAILY PATIENT CARE SERVICES AND IS THE ONLY SOURCE OF THESE SERVICES IN THE AREA. THE HOSPITAL NOW ALSO HAS AN AMBULANCE SERVICE. | Desc |
| Total Program Service Expenses | $15,109,939 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | Yes (1) | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 19 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 156 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAENA RICHARDS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4068462212 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 HOLLENBACK LANE | AddressLine1Txt |
| City | DEER LODGE | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| SCOT MURRAY | ||||||||
| MD | 40.00 | Yes (X) | $362,384 | $0 | $14,232 | |||
| JUDITH WILSON | ||||||||
| MD | 40.00 | $268,873 | $0 | $11,520 | Yes (X) | |||
| SUMERA QAMAR | ||||||||
| MD | 40.00 | Yes (X) | $227,872 | $0 | $0 | |||
| VAUGHN JOHNSON | ||||||||
| DO | 40.00 | Yes (X) | $219,935 | $0 | $18,310 | |||
| LORI DRUMM | ||||||||
| DO | 40.00 | Yes (X) | $218,465 | $0 | $29,168 | |||
| JAENA RICHARDS | ||||||||
| COO | 40.00 | Yes (X) | $161,999 | $0 | $25,092 | |||
| JENNIFER SPRING | ||||||||
| CFO | 40.00 | $115,625 | $0 | $3,469 | Yes (X) | |||
| TONY PFAFF | ||||||||
| CEO | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| LEIGHTON LEE JEWELL | ||||||||
| PRESIDENT | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| JACK ANDERSON | ||||||||
| VICE PRESIDENT | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| TERRY MOSIER | ||||||||
| SECRETARY | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| HOWARD NECKELS | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| COLTER CUMIN | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| JIM DECKER | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| CARLEE HANSEN | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,575,153 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $101,791 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 15 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CYPRESS HEALTHCARE LLC | |||||
| 791 EASTSIDE ROAD | DEER LODGE | MT | 59722 | MANAGEMENT, CEO AND REVENUE INTEGRITY SE | $453,093 |
| TRANSCENDENT ANES & PAIN SERVICE SCOTT | |||||
| 330 TRIPLE TREE RD | BOZEMAN | MT | 59715 | ANESTHESIA & PAIN MGMT. SERVICES | $256,708 |
| MONIDA SHARED IMAGING | |||||
| 1200 S RESERVE ST SUITE H | MISSOULA | MT | 59801 | MRI SERVICES | $252,888 |
| THOMAS CUISINE MANAGEMENT | |||||
| 700 E FRANKLIN ROAD | MERIDIAN | ID | 83642 | CAFE/DIETARY MANAGEMENT | $176,268 |
| PROVIDENCE HEALTH & SERVICES | |||||
| PO BOX 389762 | SEATTLE | WA | 98138 | ELECTRONIC HEALTH RECORD | $163,759 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $25,000 | RelatedOrganizationsAmt |
| Government Grants | $73,940 | GovernmentGrantsAmt |
| All Other Contributions | $13,795 | AllOtherContributionsAmt |
| Total Contributions | $112,735 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621110 | $17,190,016 | $17,190,016 |
| OTHER OPERATING REVENUE | 621110 | $1,123,518 | $1,123,518 |
| UTILIZATION FEE REVENUE | 621110 | $1,098,627 | $1,098,627 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $19,412,161 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $135,853 | TotalRevenueColumnAmt |
| Exclusion | $135,853 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $49,168 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $16,038 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $33,130 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $33,130 | TotalRevenueColumnAmt |
| Exclusion | $33,130 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,114,320 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,139,776 | SecuritiesAmt |
| Other | $5,708 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$25,456 | SecuritiesAmt |
| Other | -$5,708 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$31,164 | TotalRevenueColumnAmt |
| Exclusion | -$31,164 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $411,160 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $411,160 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $411,160 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,073,875 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,823,321 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $137,819 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $379,373 | TotalAmt |
| Program Services | $262,344 | ProgramServicesAmt |
| Management And General | $117,029 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,134,039 | TotalAmt |
| Program Services | $6,009,996 | ProgramServicesAmt |
| Management And General | $1,124,043 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,764 | TotalAmt |
| Program Services | $90,870 | ProgramServicesAmt |
| Management And General | $12,894 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,658,947 | TotalAmt |
| Program Services | $1,459,873 | ProgramServicesAmt |
| Management And General | $199,074 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $508,699 | TotalAmt |
| Program Services | $447,655 | ProgramServicesAmt |
| Management And General | $61,044 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,265 | TotalAmt |
| Management And General | $53,265 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,468,408 | TotalAmt |
| Program Services | $2,359,798 | ProgramServicesAmt |
| Management And General | $108,610 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,561 | TotalAmt |
| Management And General | $72,561 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $145,440 | TotalAmt |
| Program Services | $80,181 | ProgramServicesAmt |
| Management And General | $65,259 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $212,927 | TotalAmt |
| Program Services | $32,064 | ProgramServicesAmt |
| Management And General | $180,863 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $173,376 | TotalAmt |
| Program Services | $173,376 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,438 | TotalAmt |
| Program Services | $51,516 | ProgramServicesAmt |
| Management And General | $25,922 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $704,044 | TotalAmt |
| Program Services | $675,882 | ProgramServicesAmt |
| Management And General | $28,162 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $926,447 | TotalAmt |
| Program Services | $889,389 | ProgramServicesAmt |
| Management And General | $37,058 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $165,857 | TotalAmt |
| Program Services | $159,895 | ProgramServicesAmt |
| Management And General | $5,962 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $1,496,582 | $1,475,549 | $21,033 |
| OTHER OPERATING SUPPLIE | $744,445 | $639,421 | $105,024 |
| REPAIRS & MAINTENANCE | $159,670 | $156,516 | $3,154 |
| PHARMACEUTICALS | $82,383 | $82,383 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,302 | TotalAmt |
| Program Services | $63,231 | ProgramServicesAmt |
| Management And General | $48,071 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,378,967 | TotalAmt |
| Program Services | $15,109,939 | ProgramServicesAmt |
| Management And General | $2,269,028 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $369,658 | BOYAmt |
| EOY | $928,605 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,083,252 | BOYAmt |
| EOY | $8,524,826 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,989,642 | BOYAmt |
| EOY | $3,182,211 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $49,530 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $384,905 | BOYAmt |
| EOY | $518,763 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $139,004 | BOYAmt |
| EOY | $146,298 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $22,513,695 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $8,405,473 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,029,637 | BOYAmt |
| EOY | $14,108,222 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,075,649 | BOYAmt |
| EOY | $3,916,660 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $35,698 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,661,694 | BOYAmt |
| EOY | $2,686,916 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,733,441 | BOYAmt |
| EOY | $34,097,729 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,803,382 | BOYAmt |
| EOY | $2,299,702 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $3,394,171 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,525,000 | BOYAmt |
| EOY | $14,020,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,047,953 | BOYAmt |
| EOY | $2,275,364 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,376,335 | BOYAmt |
| EOY | $21,989,237 | 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 | $9,357,106 | BOYAmt |
| EOY | $12,108,492 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,357,106 | BOYAmt |
| EOY | $12,108,492 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,733,441 | BOYAmt |
| EOY | $34,097,729 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,694,908 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $56,478 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $695,642 | OtherCostOrOtherBasisAmt |
| Book Value | $695,642 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,081,388 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,507,589 | DepreciationAmt |
| Book Value | $11,573,799 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,417,593 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,897,884 | DepreciationAmt |
| Book Value | $1,519,709 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $319,072 | OtherCostOrOtherBasisAmt |
| Book Value | $319,072 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $14,108,222 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| BOND FUNDS | $2,345,418 |
| INVESTMENT IN YELLOWSTONE INSURANCE EXCHANGES RRG | $207,257 |
| INVESTMENT IN WORKERS COMPENSATION | $59,241 |
| INVESTMENT IN MONIDA SHARED IMAGING | $75,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,686,916 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $20,064,008 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $56,478 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $16,038 | OtherRevenueAmt |
| Revenue Not Reported | $72,516 | RevenueNotReportedAmt |
| Revenue Subtotal | $19,991,492 | RevenueSubtotalAmt |
| Other Revenues Not Included | $82,383 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $82,383 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $20,073,875 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $17,312,622 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $16,038 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $16,038 | ExpensesNotReportedAmt |
| Expenses Subtotal | $17,296,584 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $82,383 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $82,383 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $17,378,967 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE HOSPITAL IS A TAX-EXEMPT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE TAXES ON RELATED INCOME PURSUANT TO SIMILAR STATE OF MONTANA TAX LAWS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | DIRECT RENT EXPENSE DEDUCTED FROM GROSS RENTS FOR 990 REVENUE 16,038. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | 340B PHARMACEUTICAL EXPENSES NETTED W/ REVENUE ON FINANCIAL STATEMENTS 82,383. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | DIRECT RENT EXPENSE DEDUCTED FROM GROSS RENTS FOR 990 REVENUE 16,038. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | 340B PHARMACEUTICAL EXPENSES NETTED W/ REVENUE ON FINANCIAL STATEMENTS 82,383. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 250.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $648,222 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $648,222 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03730 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,776,591 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,970,905 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,424,813 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,970,905 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $648,222 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03730 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,346 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,346 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,433 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $10,433 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,779 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $15,779 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,440,592 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,970,905 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $664,001 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03830 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $75,958 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $75,958 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00440 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,555 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,555 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,317 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $22,317 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $102,830 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $102,830 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00600 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $37,161 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $7,084,130 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,266,334 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$182,204 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 CYPRESS HEALTHCARE LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | MANAGEMENT SERVICES | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.00000 | OrgProfitOrOwnershipPct |
| Ofcr Etc Profit Or Ownership | 1.00000 | OfcrEtcProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.00000 | PhysiciansProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 HOLLENBACK LANE | AddressLine1Txt |
| City | DEER LODGE | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.DLMED.ORG | WebsiteAddressTxt |
| State License | 12992 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW. DLMED.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.DLMED.ORG | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 250.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.DLMED.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.DLMED.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.DLMED.ORG | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| POWELL COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: A STEERING COMMITTEE WAS CONVENED TO ASSIST DEER LODGE MEDICAL CENTER IN CONDUCTING CHSD. A DIVERSE GROUP OF COMMUNITY MEMBERS REPRESENTING VARIOUS ORGANIZATIONS AND POPULATIONS WITHIN THE COMMUNITY (EX. PUBLIC HEALTH, ELDERLY, UNINSURED) CAME TOGETHER IN DECEMBER 2018. THE COMMITTEE MET TWICE DURING THE CHSD PROCESS; FIRST TO DISCUSS HEALTH CONCERNS IN THE COMMUNITY AND OFFER THEIR PERSPECTIVE IN DESIGNING THE SURVEY INSTRUMENT, AND AGAIN TO REVIEW RESULTS OF THE SURVEY AND FOCUS GROUPS AND TO ASSIST IN THE PRIORITIZATION OF HEALTH NEEDS TO ADDRESS. |
| POWELL COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: CHNA SIGNIFICANT NEED #1: IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICES IN POWELL COUNTY. STRATEGY #1: EXPAND BEHAVIORAL HEALTH SERVICES OFFERED AT DEER LODGE MEDICAL CENTER ACTIVITIES: HIRE FULL-TIME PSYCHIATRIST AT DLMC AND CONTINUE TO OFFER TELE-PSYCH CONSULTS IN CLINIC AND EMERGENCY ROOM STRATEGY #2: ENHANCE COMMUNITY OUTREACH AND EDUCATION RELATED TO BEHAVIORAL HEALTH IN POWELL COUNTY ACTIVITIES: DEVELOP A MENTAL/BEHAVIORAL HEALTH COMMUNITY RESOURCE PAGE HOSTED ON DLMC'S WEBSITE; CREATE MARKETING AND EDUCATIONAL OUTREACH PROMOTING NEW MH/BH RESOURCE LIST FOR DLMC STAFF, COMMUNITY PARTNERS, AND POWELL COUNTY COMMUNITY; CONTINUE TO PARTICIPATE IN COMMUNITY GROUPS/COALITIONS THAT ADDRESS BEHAVIORAL HEALTH NEEDS IN POWELL COUNTY; CONTINUE TO SUPPORT COMMUNITY PROGRAMS AND EVENTS THAT PROMOTE HEALTHY BEHAVIORS AND SUBSTANCE ABUSE PREVENTION (EX. AFTER PROM PARTY)CHNA SIGNIFICANT NEED #2: ENHANCE DEER LODGE MEDICAL CENTER'S HEALTH AND WELLNESS OUTREACH IN POWELL COUNTY. STRATEGY #1: EXPAND AND ENHANCE HEALTH AND WELLNESS PROGRAMS AND RESOURCES AT DEER LODGE MEDICAL CENTER ACTIVITIES: EXPLORE OPPORTUNITIES TO EXPAND PLANETREE MINDFULNESS AND WELLNESS PROGRAMS AT DLMC TO COMMUNITY MEMBERS; EXPLORE DEVELOPMENT AND FUNDING SOURCES FOR A COMMUNITY PARK/PLAYGROUND ON DLMC CAMPUS IN PARTNERSHIP WITH LOCAL COMMUNITY BUSINESSES AND THE CITY OF DEER LODGE; DEVELOP NUTRITIONAL OUTREACH (SUCH AS MONTHLY HEALTHY RECIPES TO BE FEATURED IN CAF AND ON DLMC FACEBOOK PAGE) THAT PROMOTE PREVENTION AND HEALTHY DIETS; CONTINUE TO PROVIDE HEALTH EDUCATION OPPORTUNITIES THAT PROMOTE HEALTH AND WELLNESS (PRE -DIABETES SUPPORT GROUP, WOMEN'S NIGHT OUT, STOP THE BLEED, HEALTH FAIR). STRATEGY #2: CONTINUE TO SUPPORT AND SPONSOR ACTIVITIES AND PROGRAMS THAT PROMOTE PHYSICAL ACTIVITY IN POWELL COUNTY ACTIVITIES: DMLC WILL PROVIDE STAFF TO PARTICIPATE ON LOCAL TRAIL COMMITTEE AND EXPLORE OPPORTUNITIES TO PROMOTE TRAIL UTILIZATION (WALK BIKE MONTANA); SPONSOR LOCAL ADULT AND YOUTH RECREATIONAL LEAGUES; CONTINUE TO HOST COMMUNITY EVENTS THAT PROMOTE PHYSICAL ACTIVITY (GOLF TOURNAMENT, ANNUAL HEALTH WALK); CONTINUE TO PROVIDE YOUTH SPORTS PHYSICALS, CONCUSSION SCREENING AND HELMET PROMOTION PROGRAM.CHNA SIGNIFICANT NEED #3: ENHANCE ACCESS TO HEALTHCARE SERVICES IN POWELL COUNTY. STRATEGY #1: IMPROVE AND SUSTAIN ACCESS TO HEALTHCARE SERVICE IN POWELL COUNTY ACTIVITIES: DLMC WILL WORK WITH AREA PARTNERS SUSTAIN AMBULANCE SERVICES IN POWELL COUNTY; DEVELOP AND IMPLEMENT A FACILITY RETENTION PLAN TO IMPROVE CONTINUITY OF PROVIDERS AND IMPROVE ACCESS TO HEALTHCARE SERVICES; CONTINUE TO PROVIDE AND PROMOTE PATIENT NAVIGATOR SERVICES LINKING PATIENTS TO COMMUNITY RESOURCES; DEVELOP FINANCIAL RESOURCES AND PROGRAMS EDUCATION FOR PATIENTS (I.E. MEDICAID, MEDICARE, 340B PROGRAM, ETC.); DEVELOP METHODOLOGY AND PROTOCOLS TO SHARE FINANCIAL ASSISTANCE RESOURCES (CLINIC, ED, WEBSITE, ETC.). STRATEGY #2: IMPROVE KNOWLEDGE OF SERVICES AVAILABLE AT DEER LODGE MEDICAL CENTER AND IN COMMUNITY ACTIVITIES: CONVENE A DLMC WORKGROUP TO DISCUSS CURRENT MARKETING EFFORTS, GAPS AND NEW OPPORTUNITIES; CREATE A COMMUNITY RESOURCES PAGE ON DLMC WEBSITE; CREATE MARKETING FLYERS/HANDOUTS FOR DLMC STAFF/PROVIDERS AND PARTNERS, DETAILING LOCAL RESOURCES (SENIOR SERVICES, MENTAL HEALTH RESOURCES, ETC.); CREATE OUTREACH/INFORMATION ABOUT DLMC PROVIDERS AND SERVICES; CONTINUE TO PROVIDE EDUCATION/PRESENTATIONS TO LOCAL ORGANIZATIONS.DLMC IS UNABLE TO ADDRESS THE FOLLOWING NEEDS AT THIS TIME:1. TOP DESIRED HEALTHCARE SERVICES NOT CURRENTLY AVAILABLE ARE URGENT CARE AND HOME HEALTH SERVICES. AT THIS TIME, IT IS NOT FINANCIALLY VIABLE FOR DLMC TO PROVIDE URGENT CARE AND/OR HOME HEALTH SERVICES. DLMC REFERS PATIENTS TO THE NEAREST RESOURCE AVAILABLE RELATED TO THESE SERVICES AS WELL AS OFFERING A 24/7 EMERGENCY DEPARTMENT.2. 9.4% OF SURVEY RESPONDENTS INDICATED THEY WORRIED THEY WOULD NOT HAVE ENOUGH FOOD TO EAT AT SOME POINT IN THE LAST YEAR. DLMC BELIEVES THERE ARE OTHER ENTITIES ADDRESSING THIS HEALTH NEED IN THE COMMUNITY. HOWEVER, DLMC PROVIDES ASSISTANCE TO THESE PROGRAMS NUMEROUS TIMES THROUGHOUT THE YEAR.3. ELDERLY TRANSPORTATION, AGING ISSUES, AND SOCIAL ISOLATION WERE IDENTIFIED BY KEY INFORMANT INTERVIEWEES AS SERVICES/NEEDS IN THE COMMUNITY. DLMC IS EXPLORING OPTIONS RELATED TO TRANSPORTATION AND SOCIAL ISOLATION. DLMC IS WORKING WITH LOCAL ORGANIZATIONS AND GROUPS TO ASSIST IN ANY WAY POSSIBLE. UPON AMBULANCE INTEGRATION WITH DLMC, TRANSPORTATION WILL BE MORE WIDELY AVAILABLE TO THOSE IN NEED.4. POWELL COUNTY HAS A HIGH RATE OF CHILDREN LIVING IN POVERTY (24.7% COMPARED TO 17.6% IN MONTANA). DLMC ASSISTS WITH PUBLIC HEALTH OFFICIALS IN THE COUNTY AND CITY. IN ADDITION, DLMC OFFERS CHARITY CARE TO THOSE WHO QUALIFY. POWELL COUNTY HEALTH DEPARTMENT IS ADDRESSING THIS ON AN ONGOING BASIS.5. POWELL COUNTY HAS A HIGHER PERCENTAGE OF WOMEN WHO REPORT SMOKING DURING PREGNANCY (22.9% VS. 16.3% IN MONTANA). DLMC DOES NOT OFFER OBSTETRIC SERVICES THEREFORE IT IS DIFFICULT TO IDENTIFY THESE INDIVIDUALS.6. POWELL COUNTY HAS A HIGH RATE OF HEPATITIS C (874.70 PER 100,000 POPULATION COMPARED TO 122.95 IN MONTANA). DLMC ASSISTS THE PUBLIC HEALTH PROGRAM BY PROVIDING TESTING FOR THESE INDIVIDUALS. DLMC IS WILLING TO ASSIST THE PUBLIC HEALTH PROGRAM AS NEEDED. |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | PCMH USED COST-TO-CHARGE RATIOS FROM ITS MOST RECENT MEDICARE COST REPORT TO DETERMINE THE COST OF FINANCIAL ASSISTANCE AND MEDICAID. COST ACCOUNTING, WHICH INCLUDED ALL SEGMENTS (INPATIENT, OUTPATIENT, ER, ET AL) WAS USED TO DETERMINE ALL OTHER AMOUNTS REPORTED IN THE TABLE.BAD DEBT EXPENSE WAS NOT A FACTOR IN CALCULATING THE PERCENTAGE FOR COLUMN F. |
| FORM 990, SCH H, PART I LINE C: | WE OFFER A 100% WRITE-OFF FOR PATIENTS/GUARANTORS WHOSE FAMILY INCOME IS OVER 250% FPG, IF THEY HAVE INCURRED OUT-OF-POCKET OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY DLMC THAT EXCEED 30% OF FAMILY INCOME. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | PHYSICAL IMPROVEMENTS AND HOUSING: PCMH EMPLOYEE SERVED ON THE COUNTY TRAILS COMMITTEE THAT WORKS TO BRING SAFE, FREE PUBLIC TRAILS TO THE COMMUNITY ($177); EMPLOYEES VOLUNTEERED TO HELP PLAN AND BUILD A COMMUNITY PLAYGROUND ($75,782).COMMUNITY SUPPORT: PCMH EMPLOYEES TOOK PART IN THE POWELL COUNTY LOCAL EMERGENCY PREPAREDNESS COMMITTEE MEETINGS AND THE PCMC PROVIDED A FREE MEETING SPACE FOR THE MEETINGS ($284). PCMH SUPPLIED PINK, LOGO-FREE JERSEYS FOR LOCAL STUDENT ATHLETES TO WEAR AS PART OF BREAST CANCER AWARENESS MONTH ($3,531), PCMH EMPLOYEES VOLUNTEERED TO HAND OUT WATER TO ATHLETES AT THE POWELL COUNTY HIGH SCHOOL CROSS COUNTRY MEET ($740).WORKFORCE DEVELOPMENT: PCMH WORKED WITH THE LOCAL HIGH SCHOOL TO PROVIDE AN INTERNSHIP FOR STUDENTS INTERESTED IN PURSUING DEGREES IN HEALTH CARE. STUDENTS ROTATED THROUGHOUT THE HOSPITAL SHADOWING VARIOUS EMPLOYEES AND DEPARTMENT HEADS ($3,742); RECRUITING HEALTH CARE PROFESSIONALS TO A MEDICAL SHORTAGE AREA ($18,575). |
| PART III, LINE 2: | TREND ANALYSIS OF SELF-PAY ACCOUNT COLLECTIONS IS USED TO CREATE AN INITIAL ESTIMATE OF THE PROVISION FOR BAD DEBT ON SELF-PAY ACCOUNTS RECEIVABLE AT FISCAL YEAR-END. THE ESTIMATE IS THEN REDUCED FOR IMPLICIT PRICE CONCESSIONS. THE INCREASE OR DECREASE IN THE PROVISION IS ADJUSTED TO BAD DEBT EXPENSE. SUBSEQUENT COLLECTIONS RECEIVED ON ACCOUNTS PREVIOUSLY WRITTEN OFF REDUCE THE CURRENT BAD DEBT EXPENSE. |
| PART III, LINE 3: | NONE OF THE ABOVE BAD DEBT IS INCLUDED AS COMMUNITY BENEFIT. |
| PART III, LINE 4: | SEE PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | BY CONTINUING TO TREAT PATIENTS ELIGIBLE FOR MEDICARE, THE HOSPITAL ALLEVIATES THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES. COST ACCOUNTING (VIA THE MEDICARE COST REPORT) WAS USED TO DETERMINE THE ALLOWABLE MEDICARE COSTS. |
| PART III, LINE 9B: | PER OUR POLICY DLMC (PCMH) WILL NOT ENGAGE IN ECAS, EITHER DIRECTLY OR BY ANY DEBT COLLECTION AGENCY OR OTHER PARTY TO WHICH DLMC HAS REFERRED THE PATIENT'S DEBT, BEFORE REASONABLE EFFORTS ARE MADE TO DETERMINE WHETHER A RESPONSIBLE INDIVIDUAL(S) IS ELIGIBLE FOR ASSISTANCE UNDER THE FAP. |
| PART VI, LINE 2: | PCHM CONTINUES TO WORK THE LOCAL SCHOOLS, THE POWELL COUNTY PUBLIC HEALTH DEPARTMENT, POWELL COUNTY LOCAL EMERGENCY PREPAREDNESS COMMITTEE, MAJOR EMPLOYERS (SUN MOUNTAIN LUMBER, MONTANA STATE PRISON), POWELL COUNTY SENIOR CITIZEN CENTER, AND POWELL COUNTY COUNCIL ON AGING TO CONTINUALLY ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY WE SERVE. WE STRONGLY ENCOURAGE EMPLOYEES TO VOLUNTEER, ON PCMH TIME, FOR ORGANIZATIONS THAT STRIVE TO IMPROVE THE WELL-BEING OF OUR COMMUNITY MEMBERS. |
| PART VI, LINE 3: | PCMH POSTS SIGNAGE THROUGHOUT THE FACILITY, ESPECIALLY AT PATIENT INTAKE AREAS, THAT NOTIFY PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. NOTICES ARE ALSO INCLUDED WITH BILLING STATEMENTS. WE'RE STRIVING TO MEET WITH EVERY SELF-PAY PATIENT TO DETERMINE THEIR ABILITY TO PAY, AND OFFER FINANCIAL ASSISTANCE, MEDICAID PRESUMPTIVE ELIGIBILITY SCREENING, OR MONTHLY PAYMENT PLANS AS NEEDED. BEFORE TURNING AN ACCOUNT OVER TO 3RD PARTY COLLECTORS, WE REVIEW THE ACCOUNTS THAT MEET THE POSSIBLE PRESUMPTIVE ELIGIBILITY CRITERIA OF OUR FINANCIAL ASSISTANCE POLICY. |
| PART VI, LINE 4: | PCMH SERVES THE COUNTIES OF POWELL, GRANITE, DEER LODGE, AND SILVER BOW, AND ALSO PROVIDES SERVICES TO INMATES AT THE MONTANA STATE PRISON. |
| PART VI, LINE 5: | THE GOVERNING BOARD OF PCMH CONSISTS OF RESIDENTS OF THE HOSPITAL'S PRIMARY SERVICE AREA. EMPLOYEES NOR INDEPENDENT CONTRACTORS (OTHER THAN DISCLOSED ON THIS FORM) OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF, ARE ALLOWED TO BE BOARD MEMBERS.PCMH EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PROVIDERS IN THE COMMUNITY. WE'VE ALSO CONTRACTED WITH SEVERAL VISITING SPECIALISTS TO OFFER SERVICES NOT OTHERWISE AVAILABLE IN OUR COMMUNITY (CARDIOLOGY, PAIN MANAGEMENT, UROLOGY, PODIATRY).PCMH CONTINUALLY REINVESTS SURPLUS FUNDS BY UPDATING OUR FACILITIES AND EQUIPMENT AND EMPLOYING ADDITIONAL STAFF TO EXPAND THE SERVICES OFFERED TO THE COMMUNITY OR IMPROVE CURRENTLY OFFERED SERVICES. SURPLUS FUNDS ARE ALSO USED TO OFFER PROGRAMS AT FREE OR REDUCED CHARGES TO THE COMMUNITY, SUCH AS THE FOLLOWING:- FREE FOOT CARE CLINIC FOR THE AGING, DISABLED AND DIABETIC COMMUNITY- FREE BLOOD PRESSURE AND BLOOD SUGAR CHECKS AT THE LOCAL SENIOR CENTER- FREE BASELINE CONCUSSION TESTING FOR LOCAL STUDENT ATHLETES- FREE MENTORING TO STUDENTS IN HEALTH CARE PROFESSIONS- SCHOLARSHIPS TO HIGH SCHOOL STUDENTS PURSUING DEGREES IN HEALTH CARESURPLUS FUNDS WERE ALSO USED TO HELP BUILD A COMMUNITY PLAYGROUND THAT WILL PROVIDE A SAFE AREA FOR THE LOCAL YOUTH TO ENJOY HEALTHY OUTDOOR PLAY. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SCOT MURRAY | ||||||||||||||
| MD | $362,384 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $14,232 | $0 | $376,616 | $0 | $0 | $0 |
| JUDITH WILSON | ||||||||||||||
| MD | $268,873 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $11,520 | $0 | $280,393 | $0 | $0 | $0 |
| SUMERA QAMAR | ||||||||||||||
| MD | $227,872 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $227,872 | $0 | $0 | $0 |
| VAUGHN JOHNSON | ||||||||||||||
| DO | $219,935 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $18,310 | $0 | $238,245 | $0 | $0 | $0 |
| LORI DRUMM | ||||||||||||||
| DO | $218,465 | $0 | $0 | $0 | $0 | $0 | $6,816 | $0 | $22,352 | $0 | $247,633 | $0 | $0 | $0 |
| JAENA RICHARDS | ||||||||||||||
| COO | $161,999 | $0 | $0 | $0 | $0 | $0 | $5,052 | $0 | $20,040 | $0 | $187,091 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MONTANA FACILITY FINANCE AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 364615115 | BondIssuerEIN |
| CUSIP | 612043GQ6 | CUSIPNum |
| Bond Issued | 2010-08-01 | BondIssuedDt |
| Issue Price | $15,000,000 | IssuePriceAmt |
| Purpose | TO FINANCE THE CONSTRUCTION AND EQUIPPING OF A NEW HEALTH CARE FACILITY | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $980,000 | RetiredAmt |
| Total Proceeds | $15,000,000 | TotalProceedsAmt |
| In Reserve Fund | $1,184,142 | InReserveFundAmt |
| Working Capital Expenditures | $13,557,042 | WorkingCapitalExpendituresAmt |
| Unspent | $258,697 | UnspentAmt |
| Substantial Completion | 2011 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | 0 | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| JACK ANDERSON | |||
| MR. ANDERSEN IS A MEMBER OF PCMC'S BOARD OF DIRECTORS. | $26,400 | MR. ANDERSEN SERVES AS THE HOSPITAL'S PHARMACIST. | 0 |
| CARLEE HANSEN | |||
| MS. HANSEN IS A MEMBER OF PCMH'S BOARD OF DIRECTORS | $11,167 | THE HOSPITAL RENTS AN APARTMENT FROM MS. HANSEN. | 0 |
| TONY PFAFF | |||
| MR. PFAFF IS PCMH'S CURRENT CEO. | $316,267 | MR. PFAFF IS THE OWNER OF CYPRESS HEALTHCARE, LLC, THE INDEPENDENT CONTRACTOR HIRED TO MANAGE THE HOSPITAL. HE RECEIVES ALL COMPENSATION FOR HIS SERVICES AS CEO FROM CYPRESS HEALTHCARE, LLC. | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 2 | THE HOSPITAL FORMED POWELL EMS IN NOVEMBER 2019. POWELL EMS ACQUIRED POWELL COUNTY AMBULANCE IN MAY OF 2020. |
| FORM 990, PART VI, SECTION A, LINE 3 | THE HOSPITAL DELEGATED CONTROL OF MANAGEMENT SERVICES TO CYPRESS HEALTHCARE, LLC. TONY PFAFF, CEO OF THE HOSPITAL, IS THE OWNER OF CYPRESS HEALTHCARE, LLC. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE CEO AND CFO REVIEW THE 990 PRIOR TO ITS FILING. THE BOARD IS THEN INFORMED THE 990 IS AVAILABLE TO BE REVIEWED AT THEIR REQUEST. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE COMPLIANCE PROGRAM IS REVIEWED ANNUALLY. ANY STAFF MEMBER CAN REPORT ANY SUSPECTED ISSUE TO THE FACILITY COMPLIANCE OFFICER. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION DETERMINATION IS A JOINT EFFORT BY THE MANAGEMENT COMPANY AND THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| PART VII, SECTION A, LINE 1A | THE ORGANIZATION'S CEO, TONY PFAFF, IS THE OWNER OF CYPRESS HEALTHCARE, LLC AND RECEIVES NO COMPENSATION FROM DEER LODGE MEDICAL CENTER. SEE SCHEDULE L FOR ADDITIONAL INFORMATION. |
| FORM 990, PART IX, LINE 11G | PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 681,476. MANAGEMENT AND GENERAL EXPENSES 52,570. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 734,046. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,678,322. MANAGEMENT AND GENERAL EXPENSES 56,040. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,734,362. |
| FORM 990, PART XII, LINE 2C: | THE ORGANIZATION HAS A COMMITTEE WHICH ASSUMES OVERSIGHT OF THE AUDIT/REVIEW OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THERE HAVE BEEN NO CHANGES TO THE POLICY IN THE CURRENT YEAR. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL EMERGENCY MEDICAL SERVICES LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 HOLLENBACK LANE | AddressLine1Txt |
| City | DEER LODGE | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 843599616 | EIN |
| Primary Activities | AMBULANCE SERVICE | PrimaryActivitiesTxt |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Total Income | $185,295 | TotalIncomeAmt |
| End Of Year Assets | $486,203 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL COUNTY MEMORIAL HOSPITAL ASSOC | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL COUNTY MEDICAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 HOLLENBACK LANE | AddressLine1Txt |
| City | DEER LODGE | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810438377 | EIN |
| Primary Activities | RAISE FUNDS FOR POWELL COUNTY MEMORIAL HOSPITAL. | PrimaryActivitiesTxt |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12C, III-FI | PublicCharityStatusTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt |
|---|---|
| POWELL COUNTY MEDICAL FOUNDATION | |
| C | $25,000 |
| POWELL COUNTY MEDICAL FOUNDATION | |
| O | $10,203 |