2021-05-17T16:16:20-05:00 2020-06-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2019-07-01 810240726 MARCUS DALY MEMORIAL HOSPITAL MARC 4063632211 1200 WESTWOOD DRIVE HAMILTON MT 59840 JOHN BISHOP CEO, SECRETARY AND TREASURER 4063632211 2021-05-12 1 KURT BENNION CPA P01469618 4252506100 2021-05-12 2019 2022-09-23 18:48:47Z JOHN BISHOP 1200 WESTWOOD DRIVE HAMILTON MT 59840 89249255 0 X WWW.MDMH.ORG X 1929 MT OUR COMMITMENT TO THE BITTERROOT VALLEY IS QUALITY, ACCESSIBLE, PERSONALIZED HEALTHCARE. 11 9 736 74 0 0 99859 4910933 77888500 77953036 237483 377798 128493 76629 78354335 83318396 74518 71519 0 0 46538871 51150742 0 0 155935 25022621 27125627 71636010 78347888 6718325 4970508 85795326 93700015 41881011 45025139 43914315 48674876 X OUR COMMITMENT TO THE BITTERROOT VALLEY IS QUALITY, ACCESSIBLE, PERSONALIZED HEALTHCARE. 0 0 63384815 71519 77953036 MARCUS DALY MEMORIAL HOSPITAL OWNS AND OPERATES A 25 LICENSED BED ACUTE CARE CRITICAL ACCESS HOSPITAL. THE HOSPITAL PROVIDES ACUTE CARE SERVICES TO PATIENTS IN RAVALLI COUNTY. THE SERVICES PROVIDED INCLUDE ACUTE CARE HOSPITAL, RELATED ANCILLARY SERVICES SUCH AS LABORATORY, RADIOLOGY, THERAPY, INPATIENT AND OUTPATIENT SURGERY, EMERGENCY CARE, AMBULANCE, HOME HEALTH, CLINIC, INPATIENT AND OUTPATIENT HOSPICE CARE. THE HOSPITAL PROVIDES EMS SERVICES WITH 3 CREWS PROVIDING 911 SERVICE TO THE COUNTY. THE GOAL IS TO RESPOND WITHIN 20 MINUTES OR LESS TO ANY CALL WITHIN THE COUNTY. THE HOSPITAL IS A PEDIATRIC REHABILITATION PROVIDER OF PHYSICAL THERAPY, OCCUPATIONAL THERAPY AND SPEECH THERAPY USING CERTIFIED THERAPISTS. THE HOSPITAL CLINICS SEE ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY AND ENABLE THE COMMUNITY ACCESS TO PRIMARY CARE. 63384815 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 92 0 736 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X X JOHN BISHOP 4063632211 1200 WESTWOOD DRIVE HAMILTON MT 59840 RICHARD DAY MD PHYSICIAN 40.00 0.00 X 1152823 0 14047 MARK CALDERWOOD MD PHYSICIAN 40.00 0.00 X 494483 0 30303 TIMOTHY WOODS MD BOARD MEMBER/PHYSICIAN 40.00 0.00 X 474963 0 32495 MICHAEL DOLECKI MD PHYSICIAN 40.00 0.00 X 476931 0 23036 BRISTOL SCHMITZ MD PHYSICIAN 40.00 0.00 X 428667 0 18165 CLINTON ADKINS MD PHYSICIAN 40.00 0.00 X 416086 0 13434 JOHN BISHOP CEO/SECRETARY/TREASURER 39.00 1.00 X 348970 0 19925 LAWRENCE BROUWER MD BOARD MEMBER/PHYSICIAN 10.00 0.00 X 192989 0 10170 DONJA ERDMAN CFO 39.00 1.00 X 163587 0 20450 LOIS HEDG-PETH CHAIRMAN 1.00 0.00 X X 0 0 0 TOM ANDERSON BOARD MEMBER 1.00 0.00 X 0 0 0 SUSANNAH BENJAMIN BOARD MEMBER 1.00 0.00 X 0 0 0 LINDA DODDS BOARD MEMBER 1.00 0.00 X 0 0 0 LISA GLENN BOARD MEMBER 1.00 0.00 X 0 0 0 BRIAN KELLEHER MD BOARD MEMBER (THROUGH SEP 2019) 1.00 0.00 X 0 0 0 TOM KORST BOARD MEMBER 1.00 0.00 X 0 0 0 MARK JERGENS MD BOARD MEMBER 1.00 0.00 X 0 0 0 ROBERT WHALEN BOARD MEMBER 1.00 0.00 X 0 0 0 BRET YOUNG BOARD MEMBER 1.00 0.00 X 0 0 0 4149499 0 182025 67 0 1 0 SWANK CONSTRUCTION PO BOX 568 VALIER MT 59486 HOSPITAL CONSTRUCTION 6678303 CERNER CORPORATION PO BOX 959156 ST LOUIS MT 63195 EHR PROVIDER 787059 HEALTHCARE OUTSOURCING NETWORK 1597 COLE BLVD 150 LAKEWOOD CO 80401 PATIENT PAYMENT ASSISTANCE 333980 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 NURSING LOCUM STAFFING 283008 BECK BUILDERS 110 FABERS WAY HAMILTON MT 59840 CONSTRUCTION 279105 11 619223 4284074 7636 4910933 NET PATIENT SERVICE REVENUE 621400 71885974 71885974 HOSPITAL UTILZTN. REV. 621400 5456266 5456266 OTHER OPERATING INCOME 621400 610796 610796 77953036 350571 350571 16166 16166 210415 255745 -45330 -45330 -45330 5685721 454 5675114 0 10607 454 11061 11061 MISCELLANEOUS 900099 106703 106703 EDUCATION 900099 12580 12580 CAFETERIA/VENDING 900099 2676 2676 121959 83318396 77953036 0 454427 71519 71519 1275414 1242904 28559 3951 40648547 32543607 8021024 83916 1526837 1223786 299786 3265 5094890 4102832 981503 10555 2605054 2047623 550716 6715 93316 93316 60595 60595 3994762 2015949 1967259 11554 85261 85261 6012298 5660900 350698 700 852107 278192 573915 348918 333501 15417 193151 162747 30404 1253446 1166148 69838 17460 5088183 4661993 409315 16875 754804 754804 PROVISION FOR BAD DEBTS 2512764 2512764 PHARMACY/ LAB EXPENSES 2271140 2252311 18829 MISCELLANEOUS EXPENSES 2203411 1068191 1134276 944 MAINTENANCE AND REPAIRS 1297454 1133325 164129 104017 66458 37559 78347888 63384815 14807138 155935 6827213 17692252 14287028 11059331 13726111 12877750 226625 333513 1987155 2361269 629788 730264 91310203 47249564 43677360 44060639 1819872 1608906 2614174 2976091 85795326 93700015 8316591 11264204 22650365 21816194 7356404 9488970 99696 3457955 2455771 41881011 45025139 X 41360334 46324424 2553981 2350452 43914315 48674876 85795326 93700015 X 4970508 1019 -210966 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 313190 2089 2089 313190 313190 183 183 313190 313190 1416 1416 313190 313190 724 724 313190 313190 984 984 313190 0.00000 1.00000 0.00000 0 0 2187280 2187280 60938616 28452422 32486194 1992636 1307426 685210 25962844 17489716 8473128 228827 228827 44060639 EMPLOYEE BENEFIT OBLIGATION 2455771 2455771 X 79715629 1019 237988 239007 79476622 3841774 3841774 83318396 76073112 237988 237988 75835124 2512764 2512764 78347888 PART V, LINE 4: THE ENDOWMENT FUND IS DESIGNATED FOR THE PURPOSE OF BUILDING AND CARRYING ON A HOSPITAL IN HAMILTON, MONTANA. THE EVANS ENDOWMENT IS TO BE USED FOR THE CARE AND TREATMENT OF CRIPPLED CHILDREN. PART X, LINE 2: PER THE AUDITED FINANCIAL STATEMENTS, NOTE 1: THE INTERNAL REVENUE SERVICE (IRS) HAS DETERMINED THAT MARCUS DALY MEMORIAL HOSPITAL IS A TAX-EXEMPT, NONPROFIT CORPORATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). THE HOSPITAL FOLLOWS THE GUIDANCE IN THE ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE GUIDANCE FURTHER PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE APPLICATION OF THIS STANDARD HAS NO IMPACT ON THE HOSPITAL'S FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 237,988. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 2,512,764. INVESTMENT INCOME 378,363. GRANTS AND CONTRIBUTIONS WITHOUT DONOR RESTRICTIONS 4,540. OTHER NONOPERATING REVENUES 170,898. CONTRIBUTIONS AND GRANTS WITH DONOR RESTRICTIONS 766,310. AUXILIARY INCOME 8,899. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 237,988. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 2,512,764. 1 1 X 1 X 1 X 1 1 0 1 1 127057 127057 0.00160 11951089 7599280 4351809 0.05550 12078146 7599280 4478866 0.05710 56751 56751 0.00070 75477 75477 0.00100 6142558 5777737 364821 0.00470 20650 20650 0.00030 6295436 5777737 517699 0.00670 18373582 13377017 4996565 0.06380 3263 3263 0.00000 53193 53193 0.00070 56456 56456 0.00070 1 2512764 0 14242644 21417191 -7174547 X 1 1 1 1 MARCUS DALY MEMORIAL HOSPITAL 1200 WESTWOOD DRIVE HAMILTON MT 59840 WWW.MDMH.ORG 12911 X X X X MARCUS DALY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 17 1 0 0 1 X SEE LINE 7D X X 1 17 1 SEE LINE 7D 0 1 X 100.000000000000 200.000000000000 X X X X X X 1 1 X X X X 1 X SEE LINE 16J X SEE LINE 16J X SEE LINE 16J X X X X X X X 1 X 0 X X X 1 X 0 0 MARCUS DALY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: MDMH GATHERED QUALITATIVE INFORMATION AND PERSPECTIVES ON COMMUNITY HEALTH NEEDS THROUGH SIXTEEN ONE-ON-ONE INTERVIEWS WITH KEY COMMUNITY STAKEHOLDERS IN FEBRUARY 2018. THE FOLLOWING AGENCIES, ORGANIZATIONS AND BUSINESSES, LISTED IN ALPHABETICAL ORDER, PARTICIPATED IN MDMH'S COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS BY CONTRIBUTING THEIR PERSPECTIVES, OPINIONS AND OBSERVATIONS.- CORVALLIS SCHOOL DISTRICT- DARBY SCHOOL DISTRICT- HAMILTON POLICE DEPARTMENT- HAMILTON SCHOOL DISTRICT- MARCUS DALY MEMORIAL HOSPITAL- MONTANA STATE UNIVERSITY COLLEGE OF NURSING- RAVALLI COUNTY COUNCIL ON AGING- RAVALLI COUNTY PUBLIC HEALTH DEPARTMENT- RAVALLI COUNTY SHERIFFS OFFICE- WESTERN MONTANA MENTAL HEALTH (RIVERFRONT) IN ADDITION TO THE INTERVIEWS, FOUR COMMUNITY FORUMS WERE HELD IN FEBRUARY 2018 IN HAMILTON, DARBY, STEVENSVILLE AND VICTOR. THESE COMMUNITY FORUMS WERE ADVERTISED TO THE COMMUNITY IN THE LOCAL NEWSPAPER, ON OUR WEBSITE, AND BY WORD OF MOUTH. IN TOTAL, EIGHTEEN COMMUNITY MEMBERS PARTICIPATED IN THE COMMUNITY FORUMS WITH DARBY HAVING THE GREATEST PARTICIPATION. MARCUS DALY MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: THE ORGANIZATION'S COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT HTTPS://WWW.MDMH.ORG/PATIENTS-AND-VISITORS/COMMUNITY-RESOURCES/COMMUNITY- HEALTH-NEEDS-ASSESSMENTS.ASPX. MARCUS DALY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: BASED IN PART ON THE 2018 COMMUNITY HEALTH NEEDS ASSESSMENT THE FOLLOWING ARE RECENT FACILITY DEVELOPMENTS AT MDMH FOR FY2020.WE HAVE ADDED COMPREHENSIVE UROLOGY CARE WITHIN THE BITTERROOT SURGICAL ASSOCIATES SPECIALTY CLINIC. AS OF SEPTEMBER 2019 ONE NEW BOARD CERTIFIED PHYSICIAN WAS HIRED TO PROVIDE REQUESTED UROLOGICAL SERVICES LOCALLY FOR THE COMMUNITY. THESE SERVICES WILL INCLUDE SPECIALIZED TESTING, DIAGNOSIS AND TREATMENT OPTIONS. IN JANUARY 2020 THE FACILITY COMPLETED INSTALLATION OF A DA VINCI ROBOTIC SURGICAL SYSTEM ALLOWING STATE-OF-THE-ART SURGICAL TECHNOLOGY. CURRENTLY THERE ARE FOUR TRAINED SURGEONS, TWO GENERAL, ONE UROLOGY, AND ONE OB/GYN.EXPANSION OF SERVICES HAS LED TO THE DEVELOPMENT OF AN INTERVENTIONAL AND ADVANCED PAIN MEDICINE, PHYSICAL MEDICINE, AND SPINE MEDICINE IN OUR BITTERROOT PAIN MANAGEMENT CLINIC. IMPLEMENTED IN MARCH 2020, BITTERROOT PAIN MANAGEMENT IS A MEDICAL CLINIC OWNED AND OPERATED BY MARCUS DALY MEMORIAL HOSPITAL, AND IS AVAILABLE FOR PATIENTS LIVING WITH PAIN AND DIAGNOSED WITH A VARIETY OF MEDICAL CONDITIONS; SUCH AS: ARTHRITIS, DEGENERATIVE DISC DISEASE, OSTEOARTHRITIS, TMJ, AND MORE. THIS SERVICE IS A KEY COMPONENT IN HELPING TO MANAGE PAIN AND REDUCE OPIOID PRESCRIBING IN THE COMMUNITY.IN DECEMBER 2019 WE RESPONDED TO COMMUNITY NEEDS WITH THE ADDITION OF DERMATOLOGY SERVICES. STAFFED BY A BOARD-CERTIFIED DERMATOLOGIST, OUR HIGHLY SKILLED SKIN CARE EXPERT TREATS PATIENTS WITH BOTH NON-CANCEROUS AND CANCEROUS SKIN CONDITIONS. IN AN EFFORT TO EXPAND ACCESS TO PRIMARY CARE SERVICES, OUR CORVALLIS FAMILY MEDICINE CLINIC EXPANDED ACCESS AND AN ADDITIONAL PROVIDER DR. MUSSMAN JOINED THE CLINIC TO ACCOMMODATE PATIENT NEEDS. ADDITIONAL HEALTHCARE INITIATIVES WERE IMPLEMENTED WITH THE EXPANSION OF DAYS AND HOURS AT OUR CONVENIENT CARE CLINIC. PATIENTS WILL HAVE ACCESS TO URGENT CARE SERVICES ALLOWING REDUCED WAIT TIMES IN THE EMERGENCY DEPARTMENT, AND IMPROVING ACCESS TO PRIMARY CARE SERVICES.IN COOPERATION WITH SAPPHIRE MENTAL HEALTH TWO LICENSED COUNSELORS HAVE BEEN FUNDED BY A GRANT TO ENHANCE THE INTEGRATED BEHAVIORAL HEALTH SERVICES PROVIDED AT OUR FACILITY. THESE COUNSELORS WILL BE LOCATED AT OUR FACILITY TO HELP TRANSITION PATIENTS TO OUTSIDE SERVICES AS NEEDED.THE COVID-19 PANDEMIC WAS THE CATALYST TO EXPEDITE A TELEHEALTH PROGRAM. OVER THE PAST TWELVE MONTHS MDMH HAS SECURED A TELEHEALTH VENDOR THAT ALLOWS PROVIDERS FROM VARIOUS AREAS TO PROVIDE TELEHEALTH SERVICES. IT IS ANTICIPATED THIS SERVICE WILL HELP IMPROVE PATIENT SATISFACTION SCORES AFTER THE COVID-19 CONCERNS ARE BEHIND US. MARCUS DALY MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: ELIGIBILITY FOR PATIENT ASSISTANCE SHALL BE MADE REGARDLESS OF RACE, GENDER, AGE, SEXUAL ORIENTATION, RELIGIOUS AFFILIATION, AND SOCIAL OR IMMIGRANT STATUS. MAJOR AREAS OF CONSIDERATIONS 1) RELATIONSHIP TO FEDERAL INCOME POVERTY GUIDELINES ADJUSTED FOR FAMILY SIZE 2) FAMILY NET ASSETS 3) DEMONSTRATION OF INABILITY TO WORK 4) COMPLETED APPLICATION AND 5) RESIDENT OF RAVALLI COUNTY MONTANA WITH EXCEPTIONS. MARCUS DALY MEMORIAL HOSPITAL PART V, SECTION B, LINE 16J: THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE ONLINE AT HTTPS://WWW.MDMH.ORG/PATIENTS-AND-VISITORS/PATIENT-BILLING/PATIENT- FINANCIAL-ASSISTANCE.ASPX. 9 1 - CORVALLIS FAMILY MEDICINE CLINIC 1037 MAIN STREET CORVALLIS MT 59828 FAMILY PRACTICE CLINIC 2 - BITTERROOT VALLEY EYE ASSOCIATES 300 N 10TH STREET HAMILTON MT 59840 OPTICAL SPECIALTY CLINIC 3 - BITTERROOT PHYSICIAN CLINIC SOUTH 3334 DVN LANE DARBY MT 59829 FAMILY PRACTICE CLINIC 4 - BITTERROOT PHYSICIAN CLINIC NORTH 2386 HIGHWAY 93 NORTH VICTOR MT 59875 FAMILY PRACTICE CLINIC 5 - BITTERROOT SURGICAL ASSOCIATES 215 N 10TH STREET SUITES AB HAMILTON MT 59840 SUGRICAL SERVICES 6 - BITTERROOT DERMATOLOGY 1103 WESTWOOD DRIVE HAMILTON MT 59840 DERMATOLOGY SERVICES 7 - MARCUS DALY HOSPICE SERVICES 1257 WESTWOOD DRIVE HAMILTON MT 59840 HOSPICE SERVICES 8 - ROCKY MOUNTAIN NEUROSURGERY CENTER 1190 WESTWOOD DRIVE HAMILTON MT 59840 NEUROSURGERY SERVICES 9 - SPECIALTY CLINIC 1150 WESTWOOD DRIVE HAMILTON MT 59840 ALLERGY/ASTHMA, PULMONOLOGY, NEPHROLOGY, ONCOLOGY, PODIATRY, ETC. PART I, LINE 3C: ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON MULTIPLE FACTORS, INCLUDING THE NATURE OF THE CONDITION AND CARE REQUIRED, INSURANCE COVERAGE OR OTHER SOURCES OF PAYMENT, INCOME (FEDERAL POVERTY LEVEL GUIDELINES ARE USED TO DETERMINE THE AMOUNT OF FINANCIAL ASSISTANCE OFFERED), FAMILY SIZE, ASSETS, AND RESIDENCY IN RAVALLI COUNTY UNLESS SERVICES WERE FOR EMERGENCY CARE.FULL FINANCIAL ASSISTANCE WILL BE GRANTED BASED ON INCOME EQUAL TO OR LESS THAN 100% OF FEDERAL POVERTY LEVEL GUIDELINES. PARTIAL ASSISTANCE MAY BE GRANTED BASED ON INCOME BETWEEN 100% AND 200% OF FEDERAL POVERTY LEVEL GUIDELINES. VALUE OF ASSETS MAY BE CONSIDERED IN DETERMINING THE LEVEL OF ASSISTANCE. PART I, LINE 7: EXPLANATION OF COSTING METHOD:FINANCIAL ASSISTANCE AT COST AND MEDICAID AMOUNTS REPORTED IN PART I, LINE 7 ARE COMPUTED USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE IRS INSTRUCTIONS. COMMUNITY HEALTH IMPROVEMENTS SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONAL EDUCATION, AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS ARE REPORTED AT COST. GENERAL SUBSIDIZED SERVICES ARE COMPUTED USING THE IRS GUIDELINES OF COST ADJUSTED NET PAYMENTS RECEIVED. THE MEDICARE COST REPORT WAS USED TO DETERMINE THE TOTAL SUBSIDY FOR THE HOME HEALTH / HOSPICE DEPARTMENTS. PART I, LINE 7G: INCLUDED IN THE SUBSIDIZED HEALTH SERVICES ARE THE FOLLOWING DEPARTMENTS: BITTERROOT SURGICAL SERVICES, BITTERROOT GENERAL/VASCULAR SURGERY, HAMILTON OB/GYN, BITTERROOT DERMATOLOGY, HOME HEALTH, AND HOSPICE AND PALLIATIVE CARE. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSES THAT WAS EXCLUDED FROM THE CALCULATION TO DETERMINE THE NET COMMUNITY BENEFIT EXPENSES AS A PERCENT OF TOTAL EXPENSES WAS $2,512,764. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITY BY PARTICIPATION IN BOTH ECONOMIC AND COALITION BUILDING EVENTS. THE HOSPITAL PARTNERS WITH LOCAL HIGH SCHOOLS, WITH A "JOB SHADOW" PROGRAM. THE GOAL IS TO EXPOSE THOSE AREA YOUTH WHO MAY BE INTERESTED IN PURSUING A CAREER IN HEALTHCARE. WE HAVE ADDED RESIDENCY TRAINING OPPORTUNITIES TO THOSE NEW PHYSICIANS WHO ARE INTERESTED IN EXPERIANCING MEDICAL PRACTICE IN A RURAL SETTING. THE HOSPITAL CONTINUES TO RECRUIT NEW PHYSICIANS TO THE AREA TO PROVIDE BASIC AND EXPANDED SERVICES TO BETTER SERVE THE NEEDS OF THE LOCAL COMMUNITY. PART III, LINE 2: BAD DEBT EXPENSE IS CALCULATED BY REVIEWING PAYMENT ARRANGEMENTS WHICH INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. PART III, LINE 3: THE HOSPITAL HAS NOT IDENTIFIED A METHOD FOR REASONABLY CALCULATING THE PORTION OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE HAD THEY APPLIED. PART III, LINE 4: SEE THE "PATIENT ACCOUNTS RECEIVABLE" PARAGRAPH ON PAGE 12 OF THE HOSPITAL'S ATTACHED AUDITED FINANCIAL STATEMENTS FOR AN EXPLANATION OF THE ORGANIZATION'S BAD DEBT EXPENSE. PART III, LINE 8: MDMH HAS A MEDICARE SHORTFALL IN EXCESS OF APPROXIMATELY $7.17 MILLION. THE HOSPITAL HAS CRITICAL ACCESS HOSPITAL STATUS AND IS REIMBURSED BY MEDICARE FOR INPATIENT AND OUTPATIENT SERVICES ON A COST BASIS AS DEFINED AND LIMITED BY THE MEDICARE PROGRAM. MDMH PROVIDES A SIGNIFICANT RURAL LINK FOR BOTH THE HEALTH AND WELL-BEING OF RAVALLI COUNTY RESIDENTS. WE ARE COMMITTED TO LOCAL HEALTHCARE CLOSE TO HOME AND WORK HARD TO EARN AND KEEP THE TRUST OF THE LOCAL COMMUNITY. TO ENSURE THAT A VARIETY OF CLINIC, HOSPITAL AND EMERGENCY SERVICES ARE OPEN AND AVAILABLE TO ALL THOSE WITHIN OUR SERVICE AREA WE STRIVE TO OPERATE AT THE HIGHEST LEVEL OF FISCAL RESPONSIBILITY AND TO BE A GOOD STEWARD OF OUR RESOURCES. THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III, LINE 6 WAS DERIVED USING THE JUNE 30, 2020 FILED MEDICARE COST REPORT. PART III, LINE 9B: IF A PATIENT IS PRESUMED TO BE FINANCIALLY INDIGENT, THE PATIENT REPRESENTATIVE WILL OFFER A PERSONAL FINANCIAL STATEMENT (PFS) TO BE FILLED OUT. THE PFS WILL BE FORWARDED TO THE PATIENT FINANCIAL ASSISTANCE COMMITTEE FOR REVIEW AND DETERMINATION OF PATIENT FINANCIAL ASSISTANCE STATUS. A PATIENT MAY REQUEST A MONTHLY PAYMENT ARRANGMENT. A MINIMUM PAYMENT OF $50 MUST BE PAID MONTHLY, WITH THE GOAL OF THE BALANCE BEING PAID IN FULL WITHIN 5 YEARS. ACCOUNTS THAT CANNOT BE COLLECTED AFTER NORMAL IN-HOUSE COLLECTION PROCEDURES MAY BE REFERRED TO A COLLECTION AGENCY, MAGISTRATE OR ATTORNEY FOR FURTHER COLLECTION ACTION. PART VI, LINE 2: BY LISTENING TO OUR PATIENTS, FRIENDS, FAMILY AND NEIGHBORS AS WE INTERACT WITH THEM DAILY WE HEAR THEIR CARES AND CONCERNS. WE ALWAYS ARE LOOKING FOR NEW WAY TO RESPOND TO, AND PROVIDE BETTER CARE FOR, THE LOCAL COMMUNITY. PART VI, LINE 3: THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM IS POSTED ON THEIR WEBSITE AT HTTPS://WWW.MDMH.ORG/PATIENTS-AND-VISITORS/PATIENT-BILLING/PATIENT- FINANCIAL-ASSISTANCE.ASPX.IN ADDITION THE HOSPITAL INFORMS PATIENTS UNABLE TO PAY THEIR BILLS ABOUT THEIR FINANCIAL ASSISTANCE WHILE TALKING TO THEM OVER THE PHONE AND SENDS THEM A FINANCIAL ASSISTANCE PACKET. PART VI, LINE 4: THE HOSPITAL SERVES A RURAL POPULATION WHERE THE PER CAPITA INCOME IS $29,761. THE PAYER MIX IS 55% MEDICARE, 16% MEDICAID, 3% SELF PAY/NO INSURANCE, WITH THE BALANCE AT OTHER COMMERCIAL PAYORS. THE UNEMPLOYMENT RATE IN RAVALLI COUNTY IS CURRENTLY AT 5% ACCORDING TO THE MONTANTA DEPARTMENT OF LABOR AND INDUSTRY. PART VI, LINE 5: THE HOSPITAL IS PROUD OF ITS EFFORTS TO PROMOTE COMMUNITY HEALTH AND WELLNESS. THE HOSPITAL CONTINUES TO PROVIDE NO-COST MAMMOGRAMS TO QUALIFIED LOW-INCOME AREA RESIDENTS. THE HOSPITAL COORDINATES AND SPONSORS THE ANNUAL SPORTS PHYSICAL CLINIC TO SUPPORT AND ENCOURAGE AREA YOUTH TO PARTICIPATE IN PHYSICAL ACTIVITIES. PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES MT 1 HAMILTON SCHOOL DISTRICT 217 DALY AVENUE HAMILTON MT 59840 816000830 GOVERNMENTAL 6500 SUPPORT FOR SCHOOL RN PROGRAM STEVENSVILLE SCHOOL DISTRICT 300 PARK STREET STEVENSVILLE MT 59870 816000829 GOVERNMENTAL 6500 SUPPORT FOR SCHOOL RN PROGRAM FLORENCE CARTON SCHOOL DISTRICT 5602 OLD HWY 93 FLORENCE MT 59833 816000836 GOVERNMENTAL 6500 SUPPORT FOR SCHOOL RN PROGRAM 3 0 PART I, LINE 2: THE HOSPITAL IS COMMITTED TO SUPPORT THE HEALTH AND WELL-BEING OF AREA SCHOOL AGED CHILDREN BY PROVIDING FUNDING GRANTS RESTRICTED TO THE DISTRICT'S SCHOOL NURSE PROGRAM. THE HOSPITAL HAS ALSO COMMITTED TO SUPPORT STUDENT ATHLETICS BY PROVIDING A VOLUNTEER BASED, LOW-COST SPORTS PHYSICAL CLINIC DURING THE SUMMER. THE PROCEEDS ARE GIVEN TO THE PARTICIPATING STUDENTS' HOME DISTRICT TO SUPPORT THE DISTRICT'S ATHLETIC PROGRAMS. OTHER COMMUNITY ORGANIZATIONS MAY SUBMIT A GRANT PROPOSAL DIRECTLY TO THE HOSPITAL CEO FOR CONSIDERATION. THE REQUESTS ARE EVALUATED BASED UPON BROAD BASED COMMUNITY SUPPORT AND THE URGENCY OF NEED. X X 1 0 X X X X X X 0 0 0 0 0 0 0 0 0 RICHARD DAY MD PHYSICIAN 1071411 0 62412 0 19000 0 13250 0 797 0 1166870 0 0 0 MARK CALDERWOOD MD PHYSICIAN 384391 0 110092 0 0 0 13250 0 17053 0 524786 0 0 0 TIMOTHY WOODS MD BOARD MEMBER/PHYSICIAN 450243 0 6000 0 18720 0 13250 0 19245 0 507458 0 0 0 MICHAEL DOLECKI MD PHYSICIAN 454431 0 4500 0 18000 0 13250 0 9786 0 499967 0 0 0 BRISTOL SCHMITZ MD PHYSICIAN 399667 0 10000 0 19000 0 0 0 18165 0 446832 0 0 0 CLINTON ADKINS MD PHYSICIAN 406586 0 9500 0 0 0 13250 0 184 0 429520 0 0 0 JOHN BISHOP CEO/SECRETARY/TREASURER 299732 0 49238 0 0 0 0 0 19925 0 368895 0 0 0 LAWRENCE BROUWER MD BOARD MEMBER/PHYSICIAN 163720 0 12269 0 17000 0 10170 0 0 0 203159 0 0 0 DONJA ERDMAN CFO 151587 0 0 0 12000 0 8833 0 11617 0 184037 0 0 0 PART I, LINE 1A THE EMPLOYEES REPORTED IN FORM 990, PART VII, SECTION A RECEIVED TAX GROSS-UP PAYMENTS FOR THEIR TAXABLE COMPENSATION RELATED TO LONG-TERM DISABILITY INSURANCE PROVIDED BY MARCUS DALY MEMORIAL HOSPITAL. THE TOTAL VALUE OF THE PAYMENTS DURING CALENDAR YEAR 2019 WAS $23,653. DR RICHARD DAY RECEIVES A NON-PAID HOUSING ALLOWANCE. THE HOUSE IS OWNED BY THE HOSPITAL AND PROVIDED TO DR. DAY AS A CONVENIENCE TO MARCUS DALY MEMORIAL HOSPITAL. A MT FACILITY FINANCE AUTHORITY 364615155 2017-06-22 9505000 REFINANCE SERIES 2000A AND SERIES 2007A BONDS AND REFINANCE EXISTING LOANS 0 0 0 B MT FACILITY FINANCE AUTHORITY 364615155 2017-12-15 15000000 FINANCE CONSTRUCTION OF A NEW SURGERY CENTER 0 0 0 A 935000 9505000 190100 9314900 2017 1 0 1 1 B 1080000 15000000 1040407 300000 13659593 2019 0 0 0 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 FORM 990, PART VI, SECTION B, LINE 11B A REPRESENTATIVE FROM CLIFTONLARSONALLEN, THE PAID PREPARER, PRESENTED THE FORM 990 TO THE HOSPITAL FINANCE COMMITTEE. UPON APPROVAL, THE FORM 990 WAS PRESENTED TO THE BOARD OF DIRECTORS FOR ACCEPTANCE AND APPROVAL PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANY DIRECTOR, CORPORATE OFFICER, SENIOR MANAGER, TRUSTEE OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, IS AN INTERESTED PERSON. IF A PERSON IS AN INTERESTED PERSON WITH RESPECT TO ANY ENTITY IN THE HEALTH CARE SYSTEM OF WHICH THE HOSPITAL IS A PART, HE OR SHE IS AN INTERESTED PERSON WITH RESPECT TO ALL ENTITIES IN THE HEALTH CARE SYSTEM. UPON APPOINTMENT, HIRE OR TRANSFER AND ANNUALLY THEREAFTER, EACH INTERESTED PERSON SHALL EXECUTE AND SUBMIT TO THE HOSPITAL'S CEO A STATEMENT WHICH AFFIRMS SUCH PERSON: A. HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; B. HAS READ AND UNDERSTANDS THE POLICY; C. HAS AGREED TO COMPLY WITH THE POLICY; AND D. UNDERSTANDS THAT THE HOSPITAL IS A CHARITABLE ORGANIZATION AND IN ORDER TO MAINTAIN ITS FEDERAL AND STATE TAX EXEMPTIONS IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE CONFLICTING FINANCIAL INTEREST AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. ANY OTHER MEMBER OF THE BOARD OR COMMITTEE MAY RAISE THE QUESTION OF WHETHER A CONFLICT EXISTS, DISCLOSE FACTS RELATING TO THE CONFLICT AND REQUEST THE INTERESTED PERSON TO PROVIDE FURTHER DETAILS. THE BOARD CHAIR (OR VICE CHAIR ACTING IN THE PLACE OF THE CHAIR) OR THE HOSPITAL'S LEGAL COUNSEL MAY, BASED ON THEIR INFORMATION ABOUT THE CONFLICT, DISCLOSE THE CONFLICT AND REQUEST THE INTERESTED PERSON TO WITHDRAW FROM DISCUSSION OF THE TRANSACTION AND/OR NOT VOTE. THE INTERESTED PERSON SHALL LEAVE THE MEETING OR REQUEST A DETERMINATION BY THE BOARD OR COMMITTEE OF WHETHER A CONFLICT OF INTEREST EXISTS. AFTER DISCLOSURE OF THE CONFLICTING INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING, DISINTERESTED BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS BEFORE CONSIDERING OR ACTING UPON ANY OTHER BUSINESS. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE HOSPITAL CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE HOSPITAL'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION, THE GOVERNING BOARD OR COMMITTEE SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. FORM 990, PART VI, SECTION B, LINE 15A ON AN ANNUAL BASIS, THE NON-CONFLICTED HOSPITAL BOARD MEMBERS (COMPENSATION COMMITTEE) RECEIVE THE ANNUAL COMPENSATION AND BENEFIT SURVEY PREPARED BY THE MONTANA HOSPITAL ASSOCIATION (MHA). THE COMMITTEE ALSO RECEIVES A REPORT FROM THE HOSPITAL THAT INCLUDES RESEARCH OF ALL CRITICAL ACCESS HOSPITALS IN THE STATES OF MONTANA, IDAHO, AND WYOMING. USING THIS INFORMATION THE COMPENSATION COMMITTEE THEN PROVIDES A RECOMMENDATION FOR CEO COMPENSATION TO THE FULL HOSPITAL BOARD. THE CEO HAS THE AUTHORITY TO SET THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE HOSPITAL. FOR PHYSICIAN COMPENSATION, THE HOSPITAL USES A THIRD-PARTY CPA FIRM TO GATHER COMPENSATION DATA FROM MGMA AND NON-PHYSICAN COMPENSATION INFORMATION IS FROM THE MHA COMPENSATION SURVEY. FORM 990, PART VI, SECTION C, LINE 18 IN ADDITION TO BEING AVAILABLE UPON REQUEST, A COPY OF THE FORM 990 IS ALSO AVAILABLE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF DALY HOSPITAL FOUNDATION -210,966. DALY HOSPITAL FOUNDATIONINC 1200 WESTWOOD DRIVE HAMILTON MT 59840 363766000 CHARITABLE SERVICES MT 501(C)(3) LINE 7 N/A 0 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0