POWELL COUNTY MEMORIAL HOSPITAL ASSOCIATION: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- POWELL COUNTY MEMORIAL HOSPITAL ASSOCIATION (EIN 81-0469886)
- Tax period
- 2017-07-01 to 2018-06-30
- Filed
- 2019-04-10
- IRS object ID
- 201911009349300926
- 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 D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-04-10T19:43:36-05:00 | ReturnTs |
| Tax Period End | 2018-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 EAST FRONT STREET 301 | AddressLine1Txt |
| City | MISSOULA | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59802 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810469886 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL COUNTY MEMORIAL HOSPITAL ASSOC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | POWE | BusinessNameControlTxt |
| Phone | 4068462212 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 HOLLENBACK LANE | AddressLine1Txt |
| City | DEER LODGE | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59722 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TONY PFAFF | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 4068462212 | PhoneNum |
| Signature | 2019-04-03 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WAYNE R HIETT CPA | PreparerPersonNm |
| PTIN | P00159424 | PTIN |
| Phone | 4067281800 | PhoneNum |
| Preparation | 2019-04-03 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 65.158.74.97 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-04-03 | IPDt |
| IP Tm | 19:02:45 | IPTm |
| IP Timezone | MD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 9D52B5E6069EE514AD23D25426376044F7108321 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEER LODGE MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TONY PFAFF | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 HOLLENBACK LANE | AddressLine1Txt |
| City | DEER LODGE | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,862,351 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | DLMED.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1991 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION OF THE HOSPITAL IS TO PROVIDE HIGH QUALITY HEALTHCARE TO ALL THEY SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 131 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $90,122 | PYContributionsGrantsAmt |
| CY Contributions Grants | $106,762 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $13,785,046 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $14,533,416 | CYProgramServiceRevenueAmt |
| PY Investment Income | $13,362 | PYInvestmentIncomeAmt |
| CY Investment Income | $18,806 | CYInvestmentIncomeAmt |
| PY Other Revenue | $240,318 | PYOtherRevenueAmt |
| CY Other Revenue | $196,390 | CYOtherRevenueAmt |
| PY Total Revenue | $14,128,848 | PYTotalRevenueAmt |
| CY Total Revenue | $14,855,374 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,949,925 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,480,234 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,827,043 | PYOtherExpensesAmt |
| CY Other Expenses | $6,163,507 | CYOtherExpensesAmt |
| PY Total Expenses | $12,776,968 | PYTotalExpensesAmt |
| CY Total Expenses | $13,643,741 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,351,880 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,211,633 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $24,314,269 | TotalAssetsBOYAmt |
| Total Assets EOY | $26,119,575 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $17,643,276 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $18,236,949 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,670,993 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $7,882,626 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE MISSION OF THE HOSPITAL IS TO PROVIDE HIGH QUALITY HEALTHCARE TO ALL THEY SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $12,137,073 | ExpenseAmt |
| Revenue | $14,533,416 | RevenueAmt |
| Desc | THE HOSPITAL PROVIDES DAILY PATIENT CARE SERVICES AND IS THE ONLY SOURCE OF THESE SERVICES IN THE AREA. | Desc |
| Total Program Service Expenses | $12,137,073 | 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 | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | 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 | 15 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 131 | 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 | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAENA RICHARDS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4068462212 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 HOLLENBACK LANE | AddressLine1Txt |
| City | DEER LODGE | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| LEIGHTON LEE JEWELL | |||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JACK ANDERSON | |||||||
| VICE PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| TERRY MOSIER | |||||||
| SECRETARY/TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| HOWARD NECKELS | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ALLEN ROME | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JIM DECKER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CARLEE HANSEN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TONY PFAFF | |||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| JAENA RICHARDS | |||||||
| CHIEF OPERATING OFFICER | 40.00 | Yes (X) | $135,509 | $0 | $14,414 | ||
| JENNIFER SPRING | |||||||
| CHIEF FINANCIAL OFFICER | 40.00 | Yes (X) | $82,302 | $0 | $891 | ||
| ERIC TREVELLINE MD | |||||||
| PHYSICIAN | 40.00 | $293,698 | $0 | $6,193 | Yes (X) | ||
| WAYNE MARTIN MD | |||||||
| PHYSICIAN | 40.00 | $266,824 | $0 | $13,860 | Yes (X) | ||
| JUDITH WILSON MD | |||||||
| PHYSICIAN | 40.00 | $221,659 | $0 | $7,724 | Yes (X) | ||
| SUMERA QAMAR | |||||||
| OD | 40.00 | $182,063 | $0 | $14,047 | Yes (X) | ||
| CYNTHIA JEAN SMITH | |||||||
| PA | 40.00 | $143,578 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,325,633 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $57,129 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 11 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CYPRESS HEALTHCARE LLC | |||||
| 791 EASTSIDE ROAD | DEER LODGE | MT | 59722 | MANAGEMENT, CEO, REVENUE INTEGRITY SERVI | $417,366 |
| ALLEVANT SOLUTIONS | |||||
| 4714 GETTYSBURG ROAD | MECHANICSBURG | PA | 17055 | TRANSITIONAL CARE PROGRAM CONSULTING SER | $220,000 |
| MONIDA SHARED IMAGING | |||||
| 1200 S RESERVE ST SUITE H | MISSOULA | MT | 59801 | MRI SERVICES | $185,739 |
| MAYO COLLABORATIVE SERVICES INC | |||||
| PO BOX 9146 | MINNEAPOLIS | MN | 554809146 | LAB TESTING SERVICES | $119,272 |
| CTA INC | |||||
| PO BOX 30071 | BILLINGS | MT | 59107 | ARCHITECTURAL SERVICES | $115,850 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $655 | RelatedOrganizationsAmt |
| Government Grants | $14,750 | GovernmentGrantsAmt |
| All Other Contributions | $91,357 | AllOtherContributionsAmt |
| Total Contributions | $106,762 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621110 | $13,875,245 | $13,875,245 |
| UTILIZATION FEE REVENUE | 621110 | $530,877 | $530,877 |
| OTHER OPERATING REVENUE | 621110 | $127,294 | $127,294 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $14,533,416 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,201 | TotalRevenueColumnAmt |
| Exclusion | $20,201 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $30,176 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $5,582 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $24,594 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,594 | TotalRevenueColumnAmt |
| Exclusion | $24,594 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,395 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$1,395 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$1,395 | TotalRevenueColumnAmt |
| Exclusion | -$1,395 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $171,796 | TotalRevenueColumnAmt |
| Exclusion | $171,796 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $171,796 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,855,374 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,533,416 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $215,196 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $218,719 | TotalAmt |
| Management And General | $218,719 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,474,195 | TotalAmt |
| Program Services | $5,167,484 | ProgramServicesAmt |
| Management And General | $306,711 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,451 | TotalAmt |
| Program Services | $45,270 | ProgramServicesAmt |
| Management And General | $3,181 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,738,869 | TotalAmt |
| Program Services | $1,488,274 | ProgramServicesAmt |
| Management And General | $250,595 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,084,760 | TotalAmt |
| Program Services | $1,872,406 | ProgramServicesAmt |
| Management And General | $212,354 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,115 | TotalAmt |
| Program Services | $4,522 | ProgramServicesAmt |
| Management And General | $45,593 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,770 | TotalAmt |
| Program Services | $30,866 | ProgramServicesAmt |
| Management And General | $1,904 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,651 | TotalAmt |
| Program Services | $38,720 | ProgramServicesAmt |
| Management And General | $22,931 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $707,987 | TotalAmt |
| Program Services | $679,668 | ProgramServicesAmt |
| Management And General | $28,319 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $875,492 | TotalAmt |
| Program Services | $840,472 | ProgramServicesAmt |
| Management And General | $35,020 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $144,853 | TotalAmt |
| Program Services | $139,304 | ProgramServicesAmt |
| Management And General | $5,549 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $1,538,617 | $1,519,892 | $18,725 |
| OTHER DIRECT EXPENSES | $585,686 | $280,947 | $304,739 |
| LICENSES & TAXES | $81,576 | $29,248 | $52,328 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,643,741 | TotalAmt |
| Program Services | $12,137,073 | ProgramServicesAmt |
| Management And General | $1,506,668 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $281,756 | BOYAmt |
| EOY | $804,675 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,499,752 | BOYAmt |
| EOY | $5,132,268 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,306,951 | BOYAmt |
| EOY | $2,101,990 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $336,583 | BOYAmt |
| EOY | $372,145 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $98,985 | BOYAmt |
| EOY | $100,594 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $21,120,230 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,809,376 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,258,674 | BOYAmt |
| EOY | $14,310,854 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,531,568 | BOYAmt |
| EOY | $3,297,049 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,314,269 | BOYAmt |
| EOY | $26,119,575 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,601,228 | BOYAmt |
| EOY | $1,773,000 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,760,000 | BOYAmt |
| EOY | $15,295,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $282,048 | BOYAmt |
| EOY | $1,168,949 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,643,276 | BOYAmt |
| EOY | $18,236,949 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,670,993 | BOYAmt |
| EOY | $7,882,626 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,670,993 | BOYAmt |
| EOY | $7,882,626 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,314,269 | BOYAmt |
| EOY | $26,119,575 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,211,633 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $695,642 | OtherCostOrOtherBasisAmt |
| Book Value | $695,642 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,923,421 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,650,570 | DepreciationAmt |
| Book Value | $10,272,851 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,656,599 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,158,806 | DepreciationAmt |
| Book Value | $1,497,793 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,844,568 | OtherCostOrOtherBasisAmt |
| Book Value | $1,844,568 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $14,310,854 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| BOND FUNDS | $3,021,404 |
| INVESTMENT IN YELLOWSTONE INSURANCE EXCHANGE RRG | $217,595 |
| INVESTMENT IN WORKERS COMPENSATION | $58,050 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,297,049 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $14,860,956 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $5,582 | OtherRevenueAmt |
| Revenue Not Reported | $5,582 | RevenueNotReportedAmt |
| Revenue Subtotal | $14,855,374 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $14,855,374 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $13,649,323 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $5,582 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $5,582 | ExpensesNotReportedAmt |
| Expenses Subtotal | $13,643,741 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $13,643,741 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE HOSPITAL IS A TAX-EXEMPT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE TAXES ON RELATED INCOME PURSUANT TO SIMILAR STATE OF MONTANA TAX LAWS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | DIRECT RENT EXPENSE DEDUCTED FROM GROSS RENTS FOR 990 REVENUE 5,582. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | DIRECT RENT EXPENSE DEDUCTED FROM GROSS RENTS FOR 990 REVENUE 5,582. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $89,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $89,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00650 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,830,443 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,406,731 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $423,712 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03110 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,919,443 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,406,731 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $512,712 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03760 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $81,539 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $81,539 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00600 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,067 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,067 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,717 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,717 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $90,323 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $90,323 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00660 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,009,766 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,406,731 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $603,035 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04420 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $662 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $662 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,610 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,610 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,782 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,782 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,054 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,054 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $652,504 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $4,004 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,350,806 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,352,539 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,733 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 CYPRESS HEALTHCARE LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | MANAGEMENT SERVICES | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.00000 | OrgProfitOrOwnershipPct |
| Ofcr Etc Profit Or Ownership | 1.00000 | OfcrEtcProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.00000 | PhysiciansProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 HOLLENBACK LANE | AddressLine1Txt |
| City | DEER LODGE | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.DLMED.ORG | WebsiteAddressTxt |
| State License | 12992 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.DLMED.ORG | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.DLMED.ORG | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| 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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.DLMED.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.DLMED.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.DLMED.ORG | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| POWELL COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: THE HOSPITAL CONVENED A STEERING COMMITTEE REPRESENTING VARIOUS ORGANIZATIONS AND POPULATIONS WITHIN THE COMMUNITY. SURVEYS TO THE GENERAL PUBLIC WERE SENT OUT AS WELL. MEMBERS OF THE STEERING COMMITTEE REPRESENTED THE AREA'S SCHOOLS, LARGEST EMPLOYERS, PUBLIC HEALTH, COUNCIL ON AGING, LOCAL CHURCHES, BANKS, AND THE COMMUNITY IN GENERAL. SEVERAL OF THESE MEMBERS WORK WITH OR FOR THE UNINSURED AND UNDERSERVED EITHER DIRECTLY THROUGH PROGRAMS DESIGNED TO ASSIST THOSE POPULATIONS, OR INDIRECTLY AS EDUCATORS, LENDERS, PASTORS, AND EMPLOYERS. |
| POWELL COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: CHNA SIGNIFICANT NEED NO. 1: ACCESS TO HEALTH CARE. PCMH IS ADDRESSING THIS NEED BY DEVELOPING AND PUBLICIZING A LIST OF ALL SERVICES AVAILABLE AT PCMH. WE CONTINUE TO ADVERTISE CURRENT AND NEW SERVICES ON (AT) BILLBOARDS, FLYERS, SOCIAL MEDIA, HEALTH FAIRS, AND JOB FAIRS. IN JULY 2018, PCMH BEGAN OFFERING CARDIO-PULMONARY REHAB SERVICES. WE PARTNER WITH POWELL COUNTY AND THE COUNCIL ON AGING TO HELP STAFF THE PUBLIC HEALTH NURSE AND HOME VISITING NURSE POSITIONS. A PCMH NURSE REGULARLY VISITS THE LOCAL SENIOR CENTER TO PROVIDE FREE BLOOD PRESSURE CHECKS AND GLUCOSE MONITORING. WE SPONSOR TICKETS FOR THE COMMUNITY VAN AND ATTEND MEETINGS OF THE TRANSPORTATION ACCESS COUNCIL. PARTNERSHIPS WITH OTHER PROVIDERS IN SURROUNDING CITIES AND STATES ARE CONTINUOUSLY PURSUED TO PROVIDE SPECIALTY SERVICES INCLUDING CARDIOLOGY, ONCOLOGY, NEUROLOGY, ORTHOPEDICS, PODIATRY, GASTROENTEROLOGY, PULMONOLOGY, AND TELEMEDICINE (STROKE, PSYCHIATRY, BURN, AND EMERGENCY).CHNA SIGNIFICANT NEED NO. 2: ALCOHOL AND SUBSTANCE ABUSE. PCMH HAS CONTRACTED TO EMPLOY A PSYCHIATRIST BEGINNING IN OCTOBER 2019. UNTIL THEN, WE HAVE IMPLEMENTED TELEPSYCHIATRY SERVICES. WE ALSO REGULARLY DONATE, BOTH IN CASH AND VOLUNTEER SERVICES, TO ACTIVITIES FOR YOUTH DESIGNED TO PROVIDE HEALTHY ALTERNATIVES TO SUBSTANCE ABUSE. CHNA SIGNIFICANT NEED NO. 3: OUTREACH AND EDUCATION. PCMH HAS INCREASED AWARENESS OF AVAILABLE HEALTHCARE RESOURCES AS MENTIONED ABOVE. WE'VE ALSO IMPLEMENTED OUTREACH AND EDUCATION SERVICES SUCH AS STOP THE BLEED AND ACTIVE SHOOTER TRAINING, AND FREE COMMUNITY HEALTH FAIRS (WITH LOW COST LAB WORK), DIABETIC EDUCATION, FOOT CLINICS, AND CONCUSSION BASELINE TESTS FOR LOCAL STUDENT ATHLETES. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | PCMH USED COST-TO-CHARGE RATIOS FROM ITS MOST RECENT MEDICARE COST REPORT TO DETERMINE THE COST OF FINANCIAL ASSISTANCE AND MEDICAID. COST ACCOUNTING, WHICH INCLUDED ALL SEGMENTS (INPATIENT, OUTPATIENT, ER, ET AL) WAS USED TO DETERMINE ALL OTHER AMOUNTS REPORTED IN THE TABLE.BAD DEBT EXPENSE WAS NOT A FACTOR IN CALCULATING THE PERCENTAGES FOR COLUMN F. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | PHYSICAL IMPROVEMENTS AND HOUSING: PCMH EMPLOYEES HELPED REPAIR THE GRANDSTANDS AT THE COUNTY FAIRGROUNDS TO MAKE THEM SAFER ($490); A PCMH EMPLOYEE SERVED ON A TRAILS COMMITTEE WORKING TO BRING FREE AND SAFE PUBLIC TRAILS TO THE AREA ($172).COMMUNITY SUPPORT: PCMH PAID AN EMPLOYEE TO ATTEND THE POWELL COUNTY LOCAL EMERGENCY PREPAREDNESS COMMITTEE AND PROVIDED THE ROOM FOR FREE TO THE COMMITTEE ($241); SEVERAL PCMH EMPLOYEES VOLUNTEERED, ON PCMH TIME, TO WORK AT THE SPORTING EVENTS OF THE LOCAL HIGH SCHOOL AND PCMH SUPPLIED PINK, LOGO-FREE, JERSEYS FOR THE ATHLETES TO WEAR AS PART OF BREAST CANCER AWARENESS MONTH ($548). |
| PART III, LINE 2: | TREND ANALYSIS OF SELF-PAY ACCOUNT COLLECTIONS IS USED TO ESTIMATE THE PROVISION FOR BAD DEBT ON SELF-PAY ACCOUNTS RECEIVABLE AT FISCAL YEAR-END. THE INCREASE OR DECREASE IN THE PROVISION IS ADJUSTED TO BAD DEBT EXPENSE. SUBSEQUENT COLLECTIONS RECEIVED ON ACCOUNTS PREVIOUSLY WRITTEN OFF REDUCE THE CURRENT BAD DEBT EXPENSE. |
| PART III, LINE 3: | AN ASSESSMENT OF INCOMPLETE FINANCIAL ASSISTANCE APPLICATIONS WAS USED TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. |
| PART III, LINE 4: | SEE PAGES 8 AND 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | NONE OF THE SHORTFALL ON LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT. COST ACCOUNTING (VIA THE MEDICARE COST REPORT) WAS USED TO DETERMINE THE ALLOWABLE MEDICARE COSTS. |
| PART III, LINE 9B: | THE BILLING AND COLLECTION POLICY MANDATED THAT A PLAIN LANGUAGE SUMMARY OF OUR FAP BE INCLUDED IN THE SECOND OR THIRD BILLING STATEMENT, ALONG WITH A FINANCIAL ASSISTANCE APPLICATION. PATIENTS COVERED BY MEDICAID ARE CONSIDERED PRESUMPTIVELY ELIGIBLE FOR FINANCIAL ASSISTANCE. |
| PART VI, LINE 2: | TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVICES, PCMH WORKS WITH COUNTY AGENCIES (I.E. PUBLIC HEALTH, SENIOR SERVICES, EMERGENCY PREPAREDNESS, ETC.), SCHOOL DISTRICTS, AND MAJOR EMPLOYERS. |
| PART VI, LINE 3: | PCMH WORKS WITH THE LOCAL MEDICAID OFFICE AND PUBLIC HEALTH AGENCY TO ASSIST QUALIFYING INDIVIDUALS WITH ACCESSING SERVICES. A PCMH STAFF MEMBER IN THE BUSINESS OFFICE IS ABLE TO ASSIST INDIVIDUALS IN APPLYING FOR MEDICAID. PATIENTS ARE INFORMED OF THE AVAILABILITY OF FINANCIAL ASSISTANCE WITH EVERY STATEMENT THEY RECEIVE. FURTHERMORE, BEING A SMALL COMMUNITY, WE OFTEN HAVE AN IDEA OF A PATIENT'S FINANCIAL SITUATION AND CAN ENCOURAGE THEM TO APPLY FOR STATE OR FEDERAL BENEFITS FOR FINANCIAL ASSISTANCE THROUGH PCMH. ALSO, BEFORE ACCOUNTS ARE SENT TO OUR 3RD PARTY COLLECTION AGENCY, THEY ARE REVIEWED TO SEE IF THEY MEET OUR PRESUMPTIVE ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE. |
| PART VI, LINE 4: | PCMH SERVES THE COUNTIES OF POWELL, GRANITE, DEER LODGE, AND SILVER BOW, AND ALSO PROVIDES SERVICES TO INMATES AT THE MONTANA STATE PRISON. |
| PART VI, LINE 5: | THE HOSPITAL'S GOVERNING BOARD IS COMPRISED OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA AND ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS (OTHER THAN DISCLOSED ON THIS FORM) OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF.PCMH EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PROVIDERS IN THE COMMUNITY.SURPLUS FUNDS ARE USED TO UPDATE FACILITIES AND EQUIPMENT OR EMPLOY ADDITIONAL STAFF IN ORDER TO EXPAND THE SERVICES OFFERED TO THE COMMUNITY OR IMPROVE CURRENTLY OFFERED SERVICES. SURPLUS FUNDS ARE ALSO USED TO OFFER PROGRAMS AT FREE OR REDUCED CHARGES TO THE COMMUNITY, SUCH AS THE FOLLOWING:- FREE ANNUAL HEALTH FAIR WITH LOW COST LAB WORK AVAILABLE- FREE STOP THE BLEED TRAINING- FREE BLOOD PRESSURE AND BLOOD SUGAR CHECKS AT THE LOCAL SENIOR CENTER- FREE BASELINE CONCUSSION TESTING FOR LOCAL STUDENT ATHLETES- DONATIONS TO THE FREE BREAKFAST PROGRAM AT THE HIGH SCHOOL- FREE MENTORING TO RN STUDENTS- SCHOLARSHIPS TO HIGH SCHOOL STUDENTS PURSUING DEGREES IN HEALTH CARE |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ERIC TREVELLINE MD | ||||||||||||||
| PHYSICIAN | $293,698 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $6,193 | $0 | $299,891 | $0 | $0 | $0 |
| WAYNE MARTIN MD | ||||||||||||||
| PHYSICIAN | $266,824 | $0 | $0 | $0 | $0 | $0 | $5,400 | $0 | $8,460 | $0 | $280,684 | $0 | $0 | $0 |
| JUDITH WILSON MD | ||||||||||||||
| PHYSICIAN | $221,659 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,724 | $0 | $229,383 | $0 | $0 | $0 |
| SUMERA QAMAR | ||||||||||||||
| OD | $182,063 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $14,047 | $0 | $196,110 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| MONTANA FACILITY FINANCE AUTHORITY | ||||||||
| A | 364615115 | 612043GQ6 | 2010-08-01 | $15,000,000 | TO FINANCE THE CONSTRUCTION AND EQUIPPING OF A NEW HEALTH CARE FACILITY | 0 | 0 | 0 |
| MONTANA FACILITY FINANCE AUTHORITY | ||||||||
| B | 364615115 | 612043GX1 | 2010-08-01 | $2,855,000 | TO FINANCE THE CONSTRUCTION AND EQUIPPING OF A NEW HEALTH CARE FACILITY | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceedsAmt | In Reserve FundInReserveFundAmt | Capital ExpendituresCapitalExpendituresAmt | UnspentUnspentAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | RetiredRetiredAmt |
|---|---|---|---|---|---|---|---|---|---|---|
| A | $15,000,000 | $1,184,142 | $13,557,042 | $258,697 | 2011 | 0 | 0 | Yes (1) | Yes (1) | |
| B | $2,855,000 | $285,605 | $2,569,395 | 2011 | 0 | 0 | Yes (1) | Yes (1) | $2,560,000 |
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 | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 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 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| JACK ANDERSEN | |||
| MR. ANDERSEN IS A MEMBER OF PCMC'S BOARD OF DIRECTORS. | $25,200 | MR. ANDERSEN SERVES AS THE HOSPITAL'S PHARMACIST. | 0 |
| TONY PFAFF | |||
| MR. PFAFF IS PCMH'S CURRENT CEO. | $177,320 | MR. PFAFF IS THE OWNER OF CYPRESS HEALTHCARE, LLC, THE INDEPENDENT CONTRACTOR HIRED TO MANAGE THE HOSPITAL. HE RECEIVES ALL COMPENSATION FOR HIS SERVICES AS CEO FROM CYPRESS HEALTHCARE, LLC. | 0 |
| CARLEE HANSEN | |||
| MS. HANSEN IS A MEMBER OF PCMH'S BOARD OF DIRECTORS | $2,280 | THE HOSPITAL RENTS AN APARTMENT FROM MS. HANSEN. | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE HOSPITAL DELEGATED CONTROL OF MANAGEMENT SERVICES TO CYPRESS HEALTHCARE, LLC. TONY PFAFF, CEO OF THE HOSPITAL, IS THE OWNER OF CYPRESS HEALTHCARE, LLC. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE CEO AND CFO REVIEW THE 990 PRIOR TO ITS FILING. THE BOARD IS THEN INFORMED THE 990 IS AVAILABLE TO BE REVIEWED AT THEIR REQUEST. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE COMPLIANCE PROGRAM IS REVIEWED ANNUALLY. ANY STAFF MEMBER CAN REPORT ANY SUSPECTED ISSUE TO THE FACILITY COMPLIANCE OFFICER. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION DETERMINATION IS A JOINT EFFORT BY THE MANAGEMENT COMPANY AND THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| PART VII, SECTION A, LINE 1A | THE ORGANIZATION'S CEO, TONY PFAFF, IS THE OWNER OF CYPRESS HEALTHCARE, LLC AND RECEIVES NO COMPENSATION FROM DEER LODGE MEDICAL CENTER. SEE SCHEDULE L FOR ADDITIONAL INFORMATION. |
| FORM 990, PART IX, LINE 11G | PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 262,619. MANAGEMENT AND GENERAL EXPENSES 62,815. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 325,434. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,609,787. MANAGEMENT AND GENERAL EXPENSES 149,539. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,759,326. |
| FORM 990 PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL COUNTY MEDICAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 HOLLENBACK LANE | AddressLine1Txt |
| City | DEER LODGE | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810438377 | EIN |
| Primary Activities | RAISE FUNDS FOR POWELL COUNTY MEMORIAL HOSPITAL. | PrimaryActivitiesTxt |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12C, III-FI | PublicCharityStatusTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt |
|---|---|
| POWELL COUNTY MEDICAL FOUNDATION | |
| O | $6,139 |
| POWELL COUNTY MEDICAL FOUNDATION | |
| C | $655 |