MARCUS DALY MEMORIAL HOSPITAL CORPORATION: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- MARCUS DALY MEMORIAL HOSPITAL CORPORATION (EIN 81-0240726)
- Tax period
- 2017-07-01 to 2018-06-30
- Filed
- 2019-04-24
- IRS object ID
- 201901149349300515
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-04-24T09:53:35-05:00 | ReturnTs |
| Tax Period End | 2018-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810240726 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARCUS DALY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MARC | BusinessNameControlTxt |
| Phone | 4063632211 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 WESTWOOD DRIVE | AddressLine1Txt |
| City | HAMILTON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59840 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN BISHOP | PersonNm |
| Person Title | CEO, SECRETARY AND TREASURER | PersonTitleTxt |
| Phone | 4063632211 | PhoneNum |
| Signature | 2019-04-24 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DARRYN MCGARVEY | PreparerPersonNm |
| PTIN | P00958683 | PTIN |
| Phone | 6123764500 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.137.57.251 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-04-24 | IPDt |
| IP Tm | 07:37:53 | IPTm |
| IP Timezone | PD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 48943B999F87A455DDDAC2F617771C67E5F72438 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 9C3E08EBF53FA5FA3C7B2B5BD0B3E335DF999A73 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2020-01-14 16:20:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JOHN BISHOP | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 WESTWOOD DRIVE | AddressLine1Txt |
| City | HAMILTON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59840 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $69,622,047 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MDMH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1929 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | OUR COMMITMENT TO THE BITTERROOT VALLEY IS QUALITY, ACCESSIBLE, PERSONALIZED HEALTHCARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 638 | TotalEmployeeCnt |
| Total Volunteers | 75 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $526,928 | PYContributionsGrantsAmt |
| CY Contributions Grants | $159,574 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $67,415,482 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $68,912,486 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$35,982 | PYInvestmentIncomeAmt |
| CY Investment Income | $103,241 | CYInvestmentIncomeAmt |
| PY Other Revenue | $216,552 | PYOtherRevenueAmt |
| CY Other Revenue | $249,312 | CYOtherRevenueAmt |
| PY Total Revenue | $68,122,980 | PYTotalRevenueAmt |
| CY Total Revenue | $69,424,613 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $58,593 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $136,750 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $39,960,075 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $43,098,401 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $156,411 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $23,233,273 | PYOtherExpensesAmt |
| CY Other Expenses | $22,586,039 | CYOtherExpensesAmt |
| PY Total Expenses | $63,251,941 | PYTotalExpensesAmt |
| CY Total Expenses | $65,821,190 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,871,039 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,603,423 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $60,014,136 | TotalAssetsBOYAmt |
| Total Assets EOY | $80,105,197 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $27,027,195 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $43,325,789 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $32,986,941 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $36,779,408 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | OUR COMMITMENT TO THE BITTERROOT VALLEY IS QUALITY, ACCESSIBLE, PERSONALIZED HEALTHCARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $54,737,433 | ExpenseAmt |
| Grant | $136,750 | GrantAmt |
| Revenue | $68,912,486 | RevenueAmt |
| Desc | MARCUS DALY MEMORIAL HOSPITAL CORPORATION 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. | Desc |
| Total Program Service Expenses | $54,737,433 | 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 |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | 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 | Yes (1) | 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 | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 89 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 638 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | 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 | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
| Other | Yes (X) | OtherInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DONJA ERDMAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4063754609 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 WESTWOOD DRIVE | AddressLine1Txt |
| City | HAMILTON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59840 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| JOHN M BARTOS CEOSECRETARY | ||||||||
| TREASURER (THROUGH JUNE 2018) | 39.00 | 1.00 | Yes (X) | Yes (X) | $348,860 | $0 | $36,422 | |
| BILL BEAN | ||||||||
| CHAIRMAN | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| LOIS HEDG-PETH | ||||||||
| VICE CHAIRMAN | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BARBARA ACKERMAN | ||||||||
| BOARD MEMBER (THROUGH OCT 2017) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| TOM ANDERSON | ||||||||
| BOARD MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| SUSANNAH BENJAMIN | ||||||||
| BOARD MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| LAWRENCE BROUWER MD | ||||||||
| BOARD MEMBER/PHYSICIAN | 10.00 | 0.00 | Yes (X) | $178,376 | $0 | $42,000 | ||
| JENNIFER FEIGHNER MD BOARD | ||||||||
| MEMBER/PHYSICIAN (THROUGH APR 2018) | 40.00 | 0.00 | Yes (X) | $308,193 | $0 | $26,210 | ||
| LISA GLENN | ||||||||
| BOARD MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| BRIAN KELLEHER MD | ||||||||
| BOARD MEMBER/PHYSICIAN | 5.00 | 0.00 | Yes (X) | $35,906 | $0 | $0 | ||
| ROBERT WHALEN | ||||||||
| BOARD MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| TIMOTHY WOODS MD | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.00 | 0.00 | Yes (X) | $458,539 | $0 | $55,981 | ||
| JOHN BISHOP CEOSECRETARY | ||||||||
| TREASURER (AS OF JUNE 2018) | 39.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DONJA C ERDMAN | ||||||||
| CFO | 39.00 | 1.00 | Yes (X) | $151,287 | $0 | $20,742 | ||
| JOHN MORELAND MD | ||||||||
| CMO | 40.00 | 0.00 | Yes (X) | $311,140 | $0 | $43,071 | ||
| TROY HANSON | ||||||||
| COO | 40.00 | 0.00 | Yes (X) | $173,401 | $0 | $21,187 | ||
| KATHRYN PADILLA RN | ||||||||
| DIRECTOR OF NURSING | 40.00 | 0.00 | Yes (X) | $117,228 | $0 | $16,450 | ||
| BRADLEY KOWALSKI | ||||||||
| CIO | 40.00 | 0.00 | Yes (X) | $139,641 | $0 | $10,173 | ||
| MARK CALDERWOOD MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $419,511 | $0 | $17,586 | Yes (X) | ||
| YVONNE COURCHESNE MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $369,633 | $0 | $17,433 | Yes (X) | ||
| RICHARD DAY MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $896,123 | $0 | $25,828 | Yes (X) | ||
| MICHAEL DOLECKI MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $458,780 | $0 | $27,785 | Yes (X) | ||
| SAMUEL URSO MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $342,542 | $0 | $24,847 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,709,160 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $385,715 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 50 | 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 |
|---|---|---|---|---|---|
| CERNER CORPORATION | |||||
| PO BOX 959156 | ST LOUIS | MO | 63195 | EHR PROVIDER | $908,651 |
| OZ ARCHITECTS | |||||
| 531 N HIGGINS AVENUE SUITE A | MISSOULA | MT | 59802 | ARCHITECTUAL SERVICES | $785,110 |
| HEALTHCARE OUTSOURCING NETWORK | |||||
| 1597 COLE BLVD 150 | LAKEWOOD | CO | 80401 | PATIENT PAYMENT ASSISTANCE | $499,764 |
| WEATHERBY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 75397 | NURSING LOCUM STAFFING | $391,515 |
| BECK BUILDERS INC | |||||
| 110 FABERS WAY | HAMILTON | MT | 59840 | HOSPITAL CONSTRUCTION | $355,617 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 16 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $111,804 | RelatedOrganizationsAmt |
| Government Grants | $20,218 | GovernmentGrantsAmt |
| All Other Contributions | $27,552 | AllOtherContributionsAmt |
| Total Contributions | $159,574 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621400 | $66,083,868 | $66,083,868 |
| HOSPITAL UTILZTN. REV. | 621400 | $2,195,680 | $2,195,680 |
| OTHER OPERATING INCOME | 621400 | $632,938 | $632,938 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $68,912,486 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $103,444 | TotalRevenueColumnAmt |
| Exclusion | $103,444 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $259,726 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $197,231 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $62,495 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $62,495 | TotalRevenueColumnAmt |
| Exclusion | $62,495 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $203 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$203 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$203 | TotalRevenueColumnAmt |
| Exclusion | -$203 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| MISCELLANEOUS | 900099 | $158,261 | $158,261 |
| EDUCATION | 900099 | $16,730 | $16,730 |
| CAFETERIA/VENDING | 900099 | $11,826 | $11,826 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $186,817 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $69,424,613 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $68,912,486 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $352,553 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $136,750 | TotalAmt |
| Program Services | $136,750 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,431,079 | TotalAmt |
| Program Services | $1,527,357 | ProgramServicesAmt |
| Management And General | $903,722 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,742,177 | TotalAmt |
| Program Services | $27,882,865 | ProgramServicesAmt |
| Management And General | $4,773,580 | ManagementAndGeneralAmt |
| Fundraising | $85,732 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,275,237 | TotalAmt |
| Program Services | $1,091,000 | ProgramServicesAmt |
| Management And General | $180,898 | ManagementAndGeneralAmt |
| Fundraising | $3,339 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,496,499 | TotalAmt |
| Program Services | $3,795,879 | ProgramServicesAmt |
| Management And General | $689,602 | ManagementAndGeneralAmt |
| Fundraising | $11,018 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,153,409 | TotalAmt |
| Program Services | $1,776,761 | ProgramServicesAmt |
| Management And General | $370,593 | ManagementAndGeneralAmt |
| Fundraising | $6,055 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $187,865 | TotalAmt |
| Management And General | $187,865 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,135 | TotalAmt |
| Management And General | $63,135 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,965,674 | TotalAmt |
| Program Services | $2,173,444 | ProgramServicesAmt |
| Management And General | $1,782,765 | ManagementAndGeneralAmt |
| Fundraising | $9,465 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,282 | TotalAmt |
| Program Services | $81,282 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,044,153 | TotalAmt |
| Program Services | $1,240,232 | ProgramServicesAmt |
| Management And General | $803,098 | ManagementAndGeneralAmt |
| Fundraising | $823 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,269,695 | TotalAmt |
| Program Services | $954,373 | ProgramServicesAmt |
| Management And General | $315,322 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $884,787 | TotalAmt |
| Program Services | $865,203 | ProgramServicesAmt |
| Management And General | $19,584 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $193,237 | TotalAmt |
| Program Services | $159,708 | ProgramServicesAmt |
| Management And General | $33,529 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $752,121 | TotalAmt |
| Program Services | $659,783 | ProgramServicesAmt |
| Management And General | $73,870 | ManagementAndGeneralAmt |
| Fundraising | $18,468 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,053,132 | TotalAmt |
| Program Services | $3,757,794 | ProgramServicesAmt |
| Management And General | $277,280 | ManagementAndGeneralAmt |
| Fundraising | $18,058 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $848,935 | TotalAmt |
| Program Services | $848,935 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| MEDICAL SUPPLIES | $2,846,043 | $2,846,043 | ||
| PROVISION FOR BAD DEBTS | $2,547,866 | $2,547,866 | ||
| PHARMACY/ LAB EXPENSES | $1,565,222 | $1,551,483 | $13,739 | |
| MAINTENANCE AND REPAIRS | $881,393 | $724,508 | $156,876 | $9 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $401,499 | TotalAmt |
| Program Services | $116,167 | ProgramServicesAmt |
| Management And General | $281,888 | ManagementAndGeneralAmt |
| Fundraising | $3,444 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,821,190 | TotalAmt |
| Program Services | $54,737,433 | ProgramServicesAmt |
| Management And General | $10,927,346 | ManagementAndGeneralAmt |
| Fundraising | $156,411 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,066,741 | BOYAmt |
| EOY | $13,054,921 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,336,122 | BOYAmt |
| EOY | $12,539,320 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,843,760 | BOYAmt |
| EOY | $10,980,931 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $272,638 | BOYAmt |
| EOY | $146,568 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,024,926 | BOYAmt |
| EOY | $2,084,849 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $484,065 | BOYAmt |
| EOY | $587,388 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $77,359,034 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $40,292,413 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,059,097 | BOYAmt |
| EOY | $37,066,621 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,241,212 | BOYAmt |
| EOY | $1,447,473 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,685,575 | BOYAmt |
| EOY | $2,197,126 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,014,136 | BOYAmt |
| EOY | $80,105,197 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,162,363 | BOYAmt |
| EOY | $7,700,100 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,534 | BOYAmt |
| EOY | $15,535 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,059,512 | BOYAmt |
| EOY | $23,477,725 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,878,906 | BOYAmt |
| EOY | $7,866,561 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $334,950 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,575,930 | BOYAmt |
| EOY | $4,265,868 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,027,195 | BOYAmt |
| EOY | $43,325,789 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,033,258 | BOYAmt |
| EOY | $34,590,066 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,250,204 | BOYAmt |
| EOY | $1,285,138 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $703,479 | BOYAmt |
| EOY | $904,204 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,986,941 | BOYAmt |
| EOY | $36,779,408 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,014,136 | BOYAmt |
| EOY | $80,105,197 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,603,423 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$17,217 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $206,261 | OtherChangesInNetAssetsAmt |
| 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
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grants Other Organizations | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $100,000 | GrantsOtherOrganizationsAmt |
| Total Lobbying Expenditures | $100,000 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | LOBBYING ACTIVITIES DURING THE FISCAL YEAR WERE TO SUPPORT BALLOT INITIATIVE TO INCREASE TOBACCO TAXES TO SUPPORT HEALTH CARE PROGRAMS. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $313,190 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,416 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,416 | OtherExpendituresAmt |
| End Year Balance | $313,190 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $313,190 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $724 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $724 | OtherExpendituresAmt |
| End Year Balance | $313,190 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $313,190 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $984 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $984 | OtherExpendituresAmt |
| End Year Balance | $313,190 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $313,190 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,019 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,019 | OtherExpendituresAmt |
| End Year Balance | $313,190 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $313,190 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $2,806 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $2,806 | OtherExpendituresAmt |
| End Year Balance | $313,190 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,187,280 | OtherCostOrOtherBasisAmt |
| Book Value | $2,187,280 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $46,569,577 | OtherCostOrOtherBasisAmt |
| Depreciation | $23,674,691 | DepreciationAmt |
| Book Value | $22,894,886 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,646,923 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,004,990 | DepreciationAmt |
| Book Value | $641,933 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,760,500 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,612,732 | DepreciationAmt |
| Book Value | $5,147,768 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,194,754 | OtherCostOrOtherBasisAmt |
| Book Value | $6,194,754 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $37,066,621 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| THIRD PARTY SETTLEMENT | $2,153,893 |
| EMPLOYEE BENEFIT OBLIGATION | $2,111,975 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,265,868 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $66,522,203 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$17,217 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $178,283 | OtherRevenueAmt |
| Revenue Not Reported | $161,066 | RevenueNotReportedAmt |
| Revenue Subtotal | $66,361,137 | RevenueSubtotalAmt |
| Other Revenues Not Included | $3,063,476 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $3,063,476 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $69,424,613 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $63,451,607 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $178,283 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $178,283 | ExpensesNotReportedAmt |
| Expenses Subtotal | $63,273,324 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $2,547,866 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $2,547,866 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $65,821,190 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, NOT-FOR-PROFIT 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 178,283. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR UNCOLLECTIBLE ACCOUNTS 2,547,866. INTEREST REVENUE 86,227. UNRESTRICTED GRANTS AND CONTRIBUTIONS 18,950. OTHER NONOPERATING REVENUES 240,411. TEMPORARILY RESTRICTED GRANTS AND CONTRIBUTIONS 160,986. AUXILIARY INCOME 9,036. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 178,283. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR UNCOLLECTIBLE ACCOUNTS 2,547,866. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $192,087 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $192,087 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00300 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,211,015 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,192,671 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,018,344 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04770 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,403,102 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,192,671 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,210,431 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05070 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $243,618 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $243,618 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00390 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $76,634 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $76,634 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,384,418 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,414,814 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,969,604 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03110 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $33,750 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $33,750 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,738,420 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,414,814 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,323,606 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03670 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,141,522 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,607,485 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,534,037 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08740 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,087 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,087 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $257,171 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $257,171 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00410 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $258,258 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $258,258 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00410 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,547,866 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $12,533,201 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $19,438,242 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$6,905,041 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARCUS DALY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 WESTWOOD DRIVE | AddressLine1Txt |
| City | HAMILTON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59840 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MDMH.ORG | WebsiteAddressTxt |
| State License | 12911 | 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 | MARCUS DALY 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 |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 17 | 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.MDMH.ORG/PATIENTS-VISITORS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.ASPX | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 17 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.MDMH.ORG/PATIENTS-VISITORS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.ASPX | 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 | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| 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 |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.MDMH.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-ASSISTANCE.ASPX | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.MDMH.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-ASSISTANCE.ASPX | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.MDMH.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-ASSISTANCE.ASPX | 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 |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 11: BASED ON THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT, MARCUS DALY MEMORIAL HOSPITAL OPENED TWO NEW CLINICS, HIRED A BEHAVIORAL HEALTH MIDLEVEL PROVIDER AT THE BITTERROOT PHYSICIANS CLINIC, CONTRACTED FOR UROLOGY SERVICES, RECRUITED A UROLOGIST WHO WILL BEGIN WORKING IN 2019, EXPANDED ACCESS TO LOCAL CARDIOLOGY SERVICES THROUGH RECRUITMENT OF A NON-INVASIVE CARDIOLOGIST, AND OFFERED VARIOUS HEALTH AND EDUCATION CLASSES TO THE COMMUNITY. DURING THE FISCAL YEAR, MDMH ALSO CONDUCTED A NEW COMMUNITY HEALTH NEEDS ASSESSMENT TO OBTAIN A MORE UP-TO-DATE UNDERSTANDING OF THE COMMUNITY'S HEALTH NEEDS. |
| MARCUS DALY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 13B: 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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 - RAVALLI UROLOGY | ||||
| 1224 WEST MAIN STREET | HAMILTON | MT | 59840 | UROLOGY SERVICES |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 PHYSICIAN CLINIC DARBY, BITTERROOT PHYSICIAN CLINIC VICTOR, RAVALLI UROLOGY, BITTERROOT GENERAL SURGERY, HAMILTON GENERAL SURGERY, HAMILTON OBGYN, AND BITTERROOT ORTHOPEDICS & SPORTS MEDICINE. |
| 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 $2,547,866. |
| 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 A RESIDENCY TRAINING OPPORTUNITIES TO THOSE NEW PHYSICIAN WHO ARE INTERESTED IN EXPERIANCING MEDICAL PRACTICE IN A RUAL SETTING. THE HOSPITAL CONTINUES TO RECRUIT NEW PHYSICIANS TO THE AREA TO PROVIDE BASIC AND EXPANDED SERVICES TO BETTER SERVE THE NEED 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 10 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 $6.9 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 2018 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 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-VISITORS/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 AVERAGE ANNUAL WAGE IS $40,065. THE PAYER MIX IS 52% MEDICARE, 18% MEDICAID, 5% SELF PAY, NO INSURANCE, WITH THE BALANCE AT OTHER COMMERCIAL PAYORS. THE UNEMPLOYMENT RATE IN RAVALLI COUNTY IS CURRENTLY AT 4.5% 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. "SPRINKLE PINK" PROGRAM IS A COMMUNITY WIDE PROGRAM THAT PROMOTES MAMMOGRAPHY SCREENING AND RAISES FUNDS 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 PHYSICIAL 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 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| HAMILTON SCHOOL DISTRICT | |||||||
| 217 DALY AVENUE | HAMILTON | MT | 59840 | 816000830 | GOVERNMENTAL | $9,100 | SUPPORT FOR SCHOOL RN PROGRAM AND STUDENT ATHLETICS |
| CORVALLIS SCHOOL DISTRICT | |||||||
| PO BOX 700 1045 MAIN STREET | CORVALLIS | MT | 59828 | 816000828 | GOVERNMENTAL | $12,150 | SUPPORT FOR SCHOOL RN PROGRAM AND STUDENT ATHLETICS |
| STEVENSVILLE SCHOOL DISTRICT | |||||||
| 300 PARK STREET | STEVENSVILLE | MT | 59870 | 816000829 | GOVERNMENTAL | $6,525 | SUPPORT FOR SCHOOL RN PROGRAM AND STUDENT ATHLETICS |
| FLORENCE CARTON SCHOOL DISTRICT | |||||||
| 5602 OLD HWY 93 | FLORENCE | MT | 59833 | 816000836 | GOVERNMENTAL | $6,500 | SUPPORT FOR SCHOOL RN PROGRAM AND STUDENT ATHLETICS |
| MARCUS DALY MEMORIAL HOSPITAL INCIDENTAL COMMITTEE | |||||||
| 1200 WESTWOOD DRIVE | HAMILTON | MT | 59840 | 810287203 | 527 | $100,000 | LOBBYING FOR A NEW MONTANA STATE TOBACCO TAX |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 4 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| Written Policy Ref T And E Expnss | 0 | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | 0 | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| 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 (12 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHN M BARTOS CEOSECRETARY | ||||||||||||||
| TREASURER (THROUGH JUNE 2018) | $335,713 | $0 | $0 | $0 | $13,147 | $0 | $24,000 | $0 | $12,422 | $0 | $385,282 | $0 | $0 | $0 |
| LAWRENCE BROUWER MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $178,376 | $0 | $0 | $0 | $0 | $0 | $42,000 | $0 | $0 | $0 | $220,376 | $0 | $0 | $0 |
| JENNIFER FEIGHNER MD BOARD | ||||||||||||||
| MEMBER/PHYSICIAN (THROUGH APR 2018) | $280,193 | $0 | $26,191 | $0 | $1,809 | $0 | $14,428 | $0 | $11,782 | $0 | $334,403 | $0 | $0 | $0 |
| TIMOTHY WOODS MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $453,596 | $0 | $3,000 | $0 | $1,943 | $0 | $42,000 | $0 | $13,981 | $0 | $514,520 | $0 | $0 | $0 |
| DONJA C ERDMAN | ||||||||||||||
| CFO | $144,725 | $0 | $0 | $0 | $6,562 | $0 | $18,000 | $0 | $2,742 | $0 | $172,029 | $0 | $0 | $0 |
| JOHN MORELAND MD | ||||||||||||||
| CMO | $267,190 | $0 | $42,181 | $0 | $1,769 | $0 | $42,000 | $0 | $1,071 | $0 | $354,211 | $0 | $0 | $0 |
| TROY HANSON | ||||||||||||||
| COO | $165,109 | $0 | $0 | $0 | $8,292 | $0 | $6,741 | $0 | $14,446 | $0 | $194,588 | $0 | $0 | $0 |
| MARK CALDERWOOD MD | ||||||||||||||
| PHYSICIAN | $381,441 | $0 | $36,127 | $0 | $1,943 | $0 | $9,796 | $0 | $7,790 | $0 | $437,097 | $0 | $0 | $0 |
| YVONNE COURCHESNE MD | ||||||||||||||
| PHYSICIAN | $257,595 | $0 | $110,299 | $0 | $1,739 | $0 | $14,508 | $0 | $2,925 | $0 | $387,066 | $0 | $0 | $0 |
| RICHARD DAY MD | ||||||||||||||
| PHYSICIAN | $830,854 | $0 | $63,326 | $0 | $1,943 | $0 | $24,000 | $0 | $1,828 | $0 | $921,951 | $0 | $0 | $0 |
| MICHAEL DOLECKI MD | ||||||||||||||
| PHYSICIAN | $455,337 | $0 | $1,500 | $0 | $1,943 | $0 | $24,000 | $0 | $3,785 | $0 | $486,565 | $0 | $0 | $0 |
| SAMUEL URSO MD | ||||||||||||||
| PHYSICIAN | $314,686 | $0 | $26,098 | $0 | $1,758 | $0 | $24,000 | $0 | $847 | $0 | $367,389 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 1A | FormAndLineReferenceDesc |
| Explanation | 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. 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 2017 WAS $33,024. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| MT FACILITY FINANCE AUTHORITY | |||||||
| A | 364615155 | 2017-06-22 | $9,505,000 | REFINANCE SERIES 2000A AND SERIES 2007A BONDS AND REFINANCE EXISTING LOANS | 0 | 0 | 0 |
| MT FACILITY FINANCE AUTHORITY | |||||||
| B | 364615155 | 2017-12-15 | $15,000,000 | FINANCE CONSTRUCTION OF A NEW SURGERY CENTER | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Other Spent ProceedsOtherSpentProceedsAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | In Reserve FundInReserveFundAmt | Capital ExpendituresCapitalExpendituresAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $275,000 | $9,505,000 | $190,100 | $9,314,900 | 2017 | Yes (1) | 0 | Yes (1) | Yes (1) | ||
| B | $15,000,000 | $300,000 | 0 | 0 | 0 | Yes (1) | $1,040,407 | $13,659,593 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | Yes (1) | 0 | 0 | 0.03450 | 0.00000 | 0.03450 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
| B | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 206,261. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DALY HOSPITAL FOUNDATIONINC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 WESTWOOD DRIVE | AddressLine1Txt |
| City | HAMILTON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59840 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363766000 | EIN |
| Primary Activities | CHARITABLE SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 7 | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| 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 | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |