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BIG HORN COUNTY MEMORIAL HOSPITAL AND HEALTH CARE FOUNDATION: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization
BIG HORN COUNTY MEMORIAL HOSPITAL AND HEALTH CARE FOUNDATION (EIN 81-0504410)
Tax period
2018-07-01 to 2019-06-30
Filed
2020-07-13
IRS object ID
202011959349304456
Schema version
2018v3.2
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 ReturnHeader

FieldValueIRS element (for citing)
Return2020-07-13T18:47:59-05:00ReturnTs
Tax Period End2019-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1220 SOUTH SIXTH STREET SUITE 300AddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55402ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2018-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN810504410EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1BIG HORN COUNTY HOSPITAL AND HEALTH CAREBusinessNameLine1Txt
Business Name Line2FOUNDATIONBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlBIGHBusinessNameControlTxt
Phone4066652310PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line117 NORTH MILES AVENUEAddressLine1Txt
CityHARDINCityNm
State AbbreviationMTStateAbbreviationCd
ZIP59034ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonKRISTI GATRELLPersonNm
Person TitleCEOPersonTitleTxt
Phone4066652310PhoneNum
Signature2020-07-09SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonROBERT E SCHILEPreparerPersonNm
PTINP00369682PTIN
Phone6123764500PhoneNum
Preparation2020-07-09PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address67.137.57.251IPv4AddressTxt
FieldValueIRS element (for citing)
IP2020-07-09IPDt
IP Tm10:04:32IPTm
IP TimezoneCDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id9C1DED54EE6A56468881F41BE7A7DD662CF8FCB7AtSubmissionCreationDeviceId
At Submission Filing Device Id8DF0D5A1DBF8E44DE93554FEEDBEEE801640FE4CAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2018TaxYr
Build TS2020-09-22 18:59:49ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerWILLIAM HODGESPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line117 NORTH MILES AVENUEAddressLine1Txt
CityHARDINCityNm
State AbbreviationMTStateAbbreviationCd
ZIP59034ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$453,192GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.BIGHORNHOSPITAL.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1994FormationYr
Legal Domicile StateMTLegalDomicileStateCd
Activity Or MissionBENEFIT AND SUPPORT OF BIG HORN HOSPITAL ASSOCIATIONActivityOrMissionDesc
Voting Members Governing Body6VotingMembersGoverningBodyCnt
Voting Members Independent5VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers6TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$105,582PYContributionsGrantsAmt
CY Contributions Grants$164,881CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$34,037PYInvestmentIncomeAmt
CY Investment Income$50,995CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$139,619PYTotalRevenueAmt
CY Total Revenue$215,876CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$51,028PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$54,990CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$20,439PYOtherExpensesAmt
CY Other Expenses$30,371CYOtherExpensesAmt
PY Total Expenses$71,467PYTotalExpensesAmt
CY Total Expenses$85,361CYTotalExpensesAmt
PY Revenues Less Expenses$68,152PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$130,515CYRevenuesLessExpensesAmt
Total Assets BOY$711,035TotalAssetsBOYAmt
Total Assets EOY$828,787TotalAssetsEOYAmt
Total Liabilities BOY$0TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$711,035NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$828,787NetAssetsOrFundBalancesEOYAmt
MissionTO PROVIDE FUNDRAISING AND FINANCIAL SUPPORT TO BIG HORN HOSPITAL ASSOCIATION FOR PROJECTS TO INCREASE AND IMPROVE SERVICES AT THE HOSPITAL AND NURSING HOME AND THEIR PATIENTS/RESIDENTS.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$0ExpenseAmt
Grant$0GrantAmt
Revenue$0RevenueAmt
DescVARIOUS PROGRAMS, PROVIDING SUPPORT TO BIG HORN HOSPITAL TO COVER OPERATING COSTS, PATIENT CARE AND OTHER FUNDING NEEDS. DURING THE YEAR, FUNDRAISING CONTINUED FOR "BUILDING YOUR HEALTHCARE FUTURE" CAPITAL CAMPAIGN THAT BEGAN IN FISCAL YEAR 2018 TO RAISE FUNDS FOR AN $11 MILLION REMODEL PROJECT FOR BIG HORN COUNTY MEMORIAL HOSPITAL. THIS PROJECT WILL INCLUDE A NEW ER WING WITH ADDITIONAL ER BAYS, CONSOLIDATION OF PATIENT ROOMS, IMAGING DEPARTMENT AND NURSES STATION. MORE HIPAA COMPLIANT CHECK IN FOR PATIENTS.Desc
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members6GoverningBodyVotingMembersCnt
Independent Voting Member5IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ROXIE CAINBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone4066659222PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line117 N MILES AVENUEAddressLine1Txt
CityHARDINCityNm
State AbbreviationMTStateAbbreviationCd
ZIP59034ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
TERRY BULLIS
CHAIRMAN0.200.40Yes (X)Yes (X)$0$0$0
THOR TORSKE
SECRETARY/TREASURER0.200.40Yes (X)Yes (X)$0$0$0
JAMES SEYKORA
FUNDRAISING CHAIR0.200.40Yes (X)$0$0$0
DONNA STRICKER
AUXILIARY MEMBER0.200.00Yes (X)$0$0$0
DR ED ARNOLD
BOARD MEMBER (THROUGH DEC 2018)0.200.00Yes (X)$0$0$0
DR SHANNON WAGENMAN
BOARD MEMBER0.2040.00Yes (X)$0$142,504$27,104
WILLIAM HODGES
EXECUTIVE DIRECTOR25.0015.00Yes (X)$0$93,933$21,189
KRISTI GATTRELL
CEO1.0039.00Yes (X)$0$116,959$21,189
ROXIE CAIN
CONTROLLER1.0039.00Yes (X)$0$108,688$27,104
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$462,084TotReportableCompRltdOrgAmt
Total Other Compensation$96,586TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Related Organizations$24,560RelatedOrganizationsAmt
All Other Contributions$140,321AllOtherContributionsAmt
Total Contributions$164,881TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$31,084TotalRevenueColumnAmt
Exclusion$31,084ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$257,227SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$237,316SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$19,911SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$19,911TotalRevenueColumnAmt
Exclusion$19,911ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$215,876TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$50,995ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$51,831TotalAmt
Management And General$51,831ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$3,159TotalAmt
Management And General$3,159ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$2,625TotalAmt
Management And General$2,625ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$12,828TotalAmt
Management And General$12,828ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$337TotalAmt
Management And General$337ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$1,823TotalAmt
Management And General$1,823ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtManagement And GeneralManagementAndGeneralAmt
MISCELLANEOUS EXPENSE$10,631$10,631
TAXES & LICENSES$2,127$2,127

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$85,361TotalAmt
Program Services$0ProgramServicesAmt
Management And General$85,361ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,728BOYAmt
EOY$69,687EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$5,807BOYAmt
EOY$5,819EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$703,500BOYAmt
EOY$753,281EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$711,035BOYAmt
EOY$828,787EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$711,035BOYAmt
EOY$828,787EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$711,035BOYAmt
EOY$828,787EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$711,035BOYAmt
EOY$828,787EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$130,515ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$12,763NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit Committee0AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1BIG HORN HOSPITAL ASSOCIATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN810384618EIN
Organization Type3OrganizationTypeCd
Governing Document ListedYes (1)GoverningDocumentListedInd
Support$0SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$0SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS Determination0SuprtOrgNoIRSDeterminationInd
Supported Org Section C4560SupportedOrgSectionC456Ind
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org0OrganizationChangeSuprtOrgInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules0ExcessBusinessHoldingsRulesInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (1)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt Org0OperateBenefitNonSuprtOrgInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

FieldValueIRS element (for citing)
PersonDR SHANNON WAGENMANPersonNm
TitleBOARD MEMBERTitleTxt
Base Compensation Filing Org$0BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs$142,504CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization$0BonusFilingOrganizationAmount
Bonus Related Organizations$0BonusRelatedOrganizationsAmt
Other Compensation Filing Org$0OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs$0OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org$0DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs$2,500DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org$0NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$24,604NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$0TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs$169,608TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org$0CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs$0CompReportPrior990RltdOrgsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6THE MEMBERSHIP OF THE FOUNDATION, SUBJECT TO AVAILABILITY TO SERVE, CONSISTS OF AT LEAST THE FOLLOWING: A. ALL OF THE MEMBERS OF THE BOARD OF DIRECTORS OF BIG HORN HOSPITAL ASSOCIATION OF BIG HORN COUNTY, MONTANA. B. ONE MEMBER OF THE ACTIVE MEDICAL STAFF OF BIG HORN COUNTY MEMORIAL HOSPITAL OF BIG HORN COUNTY, MONTANA, WHO IS A RESIDENT OF BIG HORN COUNTY. C. SUCH OTHER MEMBERS AS DETERMINED AND AUTHORIZED BY THE FOREGOING EXISTING MEMBERSHIP. ALL MEMBERS OF EXISTING AUXILIARY ORGANIZATIONS WHICH ARE AFFILIATED WITH BIG HORN HOSPITAL ASSOCIATION ARE ENTITLED TO BECOME MEMBERS OF THE FOUNDATION.
FORM 990, PART VI, SECTION A, LINE 7ATHREE MEMBERS OF THE BOARD OF DIRECTORS ARE DULY APPOINTED AND ACTING MEMBERS OF THE BOARD OF DIRECTORS OF BIG HORN HOSPITAL ASSOCIATION. THEY ARE ELECTED BY THE BOARD OF DIRECTORS OF BIG HORN HOSPITAL ASSOCIATION. ONE MEMBER OF THE BOARD OF DIRECTORS IS ELECTED BY THE ACTIVE MEDICAL STAFF OF BIG HORN COUNTY MEMORIAL HOSPITAL.
FORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 WAS REVIEWED IN DETAIL BY BOTH THE HOSPITAL CEO AND CONTROLLER, AS WELL AS THE FOUNDATION DIRECTOR. THE BOARD MEMBERS WERE PROVIDED A COPY OF THE FORM 990 AFTER IT WAS FILED.
FORM 990, PART VI, SECTION B, LINE 12CREGULAR COMPLIANCE MEETINGS DISCUSS ANY ACTUAL CONFLICTS OR POTENTIAL CONFLICTS. THERE IS ALSO A HOTLINE NUMBER TO CALL FOR COMPLIANCE OR HIPAA ISSUES THAT IS OPERATED BY MONTANA HOSPITAL ASSOCIATION, NOT BIG HORN HOSPITAL ASSOCIATION. BOARD MEMBERS SIGN YEARLY CONFLICT OF INTEREST STATEMENTS AND IF A CONFLICT OCCURS ON A SPECIFIC ITEM, THEY ABSTAIN FROM THE VOTE ON THAT ITEM.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE UNAVAILABLE TO THE PUBLIC.
FORM 990, PART IX, LINE 11GPURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 12,828. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,828.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1BIG HORN HOSPITAL ASSOCIATIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line117 NORTH MILES AVENUEAddressLine1Txt
CityHARDINCityNm
State AbbreviationMTStateAbbreviationCd
ZIP59034ZIPCd
FieldValueIRS element (for citing)
EIN810384618EIN
Primary ActivitiesHOSPITALPrimaryActivitiesTxt
Legal Domicile StateMTLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 3PublicCharityStatusTxt
Direct Controlling NAN/ADirectControllingNACd
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd